Provider Demographics
NPI:1861869786
Name:ABHS INC
Entity type:Organization
Organization Name:ABHS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHANNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-455-1222
Mailing Address - Street 1:524 CLEVELAND BLVD
Mailing Address - Street 2:230
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4076
Mailing Address - Country:US
Mailing Address - Phone:205-455-1222
Mailing Address - Fax:
Practice Address - Street 1:524 CLEVELAND BLVD
Practice Address - Street 2:230
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4076
Practice Address - Country:US
Practice Address - Phone:205-455-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
ID152380008251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID152380008Medicaid