| Altitude Mental Health | |
|
8100 W Emerald St Ste 180 Boise ID 83704-9069 | |
| (208) 342-6300 | |
| (208) 342-6301 |
| Full Name | Altitude Mental Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 8100 W Emerald St Ste 180, Boise, Idaho |
| Authorized Official Name and Position | Anthony Upshaw (BUSINESS MANAGER) |
| Authorized Official Contact | 2086961388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Altitude Mental Health 8100 W Emerald St Ste 180 Boise ID 83704-9069 Ph: (208) 342-6300 | Altitude Mental Health 8100 W Emerald St Ste 180 Boise ID 83704-9069 Ph: (208) 342-6300 |
| NPI Number | 1497359715 |
|---|---|
| Provider Enumeration Date | 11/27/2020 |
| Last Update Date | 09/12/2022 |
| Certification Date | 09/12/2022 |
| Medicare PECOS PAC ID | 3577978907 |
|---|---|
| Medicare Enrollment ID | O20210217002674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497359715 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Daniel J Allen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720017247 PECOS PAC ID: 9830197060 Enrollment ID: I20061121000714 |
| Provider Name | Kenneth A Wells |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912413279 PECOS PAC ID: 4284063744 Enrollment ID: I20200706001296 |
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