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NPI Code Detail

MEDICARE: BOISE OPERATIONS, LLC

MEDICARE: BOISE OPERATIONS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1245574896
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOISE OPERATIONS, LLC
Provider Business Mailing Address
First Line : 25117 SW PARKWAY AVE
Second Line : SUITE F
City : WILSONVILLE
State : OR
Zip : 97070-9697
Country : US
Telephone Number : 503-570-3405
Fax Number : 503-570-3315
Provider Business Practice Location Address
First Line : 1001 S HILTON ST
Second Line :
City : BOISE
State : ID
Zip : 83705-1925
Country : US
Telephone Number : 208-345-4464
Fax Number : 208-345-2998
Authorized Official
Title or Position : CHAIRMAN
Name : KARL MILLER JR.
Credential :
Telephone Number : 503-570-3405
Provider Enumeration Date : 11/20/2012
Last Update Date : 03/04/2013

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Directions to “BOISE OPERATIONS, LLC ” Practice Location

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