Provider Demographics
NPI:1447452800
Name:BLMH MENTAL HEALTH
Entity type:Organization
Organization Name:BLMH MENTAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SHAE
Authorized Official - Middle Name:JAYDEN
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-847-4464
Mailing Address - Street 1:455 WASHINGTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-1600
Mailing Address - Country:US
Mailing Address - Phone:208-847-4464
Mailing Address - Fax:208-847-3093
Practice Address - Street 1:455 WASHINGTON ST
Practice Address - Street 2:STE 2
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-1600
Practice Address - Country:US
Practice Address - Phone:208-847-4464
Practice Address - Fax:208-847-3093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAR LAKE COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-05
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID35251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804083400Medicaid
ID805405600Medicaid