ASHTON MEMORIAL INC — NPI 1104665587 (Licensed & Credentialed Residential Treatment Facility, Emotionally Disturbed Children in IDAHO FALLS, ID)

CMS-1500 Box 24J / 33a • NPI

1104665587

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

322D00000X

Licensed & Credentialed Residential Treatment Facility, Emotionally Disturbed Children

Box 32 Service Location & ZIP+4

2935 ROLLANDET ST, IDAHO FALLS, ID, 83402-4654

✓ 9-Digit EDI 837 ZIP+4 (83402-4654)

Practice Phone & Referral Fax

(208) 542-2905

Fax: (208) 522-2427

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104665587 (ASHTON MEMORIAL INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104665587` (NPI-2 Organization / Facility)
Provider / Legal Name	ASHTON MEMORIAL INC
Plain-English Specialty	Licensed & Credentialed Residential Treatment Facility, Emotionally Disturbed Children NUCC Code: `322D00000X` (Residential Treatment Facility, Emotionally Disturbed Children)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2935 ROLLANDET ST, IDAHO FALLS, ID, 83402-4654
Practice Telephone / Fax	Tel: (208) 542-2905 \| Fax: (208) 522-2427
Administrative Mailing Address	PO BOX 838, ASHTON, ID, 83420-0838
Enumeration & Last Sync	Enumerated: 2024-05-23 \| CMS Record Updated: 2024-05-23
Authorized Official	SUZANNE BRADY (HR Director/Compliance Officer)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2935 ROLLANDET ST, IDAHO FALLS, ID, 83402-4654

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Plain-English Taxonomy & CMS Crosswalk (322D00000X)

What Does Taxonomy Code 322D00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 322D00000X translates to:
"Licensed & Credentialed Residential Treatment Facility, Emotionally Disturbed Children"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Residential Treatment Facility, Emotionally Disturbed Children for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ASHTON MEMORIAL INC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`322D00000X` — Residential Treatment Facility, Emotionally Disturbed Children Plain English: Licensed & Credentialed Residential Treatment Facility, Emotionally Disturbed Children	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ASHTON MEMORIAL INC (NPI #1104665587)