Provider Demographics
NPI:1316648546
Name:EAST IDAHO YOUTH HOMES LLC DDA
Entity type:Organization
Organization Name:EAST IDAHO YOUTH HOMES LLC DDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:TORNKVIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-360-8102
Mailing Address - Street 1:550 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4149
Mailing Address - Country:US
Mailing Address - Phone:208-360-8102
Mailing Address - Fax:
Practice Address - Street 1:983 CURLEW DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4706
Practice Address - Country:US
Practice Address - Phone:208-881-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST IDAHO YOUTH HOMES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty