MEDICARE: BH-ID OPCO IF, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1174488746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BH-ID OPCO IF, LLC

Provider Business Mailing Address
First Line	:	PO BOX 12125
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-0125
Country	:	US
Telephone Number	:	619-889-3399
Fax Number	:

Provider Business Practice Location Address
First Line	:	383 ENERGY DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-4880
Country	:	US
Telephone Number	:	986-202-8190
Fax Number	:

Authorized Official
Title or Position	:	GENERAL COUNSEL
Name	:	CHAD ENGBRECHT
Credential	:
Telephone Number	:	858-254-2510

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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