Provider Demographics
NPI:1104048503
Name:COMMUNITY PARTNERSHIPS OF IDAHO, INC.
Entity type:Organization
Organization Name:COMMUNITY PARTNERSHIPS OF IDAHO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-405-0587
Mailing Address - Street 1:3098 N FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5215
Mailing Address - Country:US
Mailing Address - Phone:208-376-4999
Mailing Address - Fax:208-376-4988
Practice Address - Street 1:3214 N ACRE LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4501
Practice Address - Country:US
Practice Address - Phone:208-376-7846
Practice Address - Fax:208-549-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8060419Medicaid