OrganizationActive
State of Idaho
NPI 1962755868 · Intellectual Disabilities Intermediate Care Facility · Hayden, ID
Provider details
- NPI number
- 1962755868
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Authorized official
- Susan Broetje, Administrator
- License
- 81 (ID)
Practice location
1182 West Kyler Ave
Hayden, ID 83835
Phone: (208) 762-0244
Fax: (208) 762-0269
Mailing address
1660 11th Ave N
Nampa, ID 83687-5000
Registry dates
- Enumerated
- 2012-10-17
- Last updated
- 2012-10-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.