MEDICARE: COMMUNITY PARTNERSHIPS OF IDAHO, INC.

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	251S00000X	Community/Behavioral Health Agency
2	261QD1600X	Developmental Disabilities Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851513295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY PARTNERSHIPS OF IDAHO, INC.

Provider Business Mailing Address
First Line	:	3098 N FIVE MILE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-5215
Country	:	US
Telephone Number	:	208-376-4999
Fax Number	:	208-376-4988

Provider Business Practice Location Address
First Line	:	3076 N FIVE MILE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-5215
Country	:	US
Telephone Number	:	208-376-4999
Fax Number	:	208-376-4988

Authorized Official
Title or Position	:	MANAGER
Name	:	VICTORIA BRIGHT
Credential	:
Telephone Number	:	208-405-0587

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	09/09/2019

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