MEDICARE: ELMORE MEDICAL CENTER LTC

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
1	313M00000X	Nursing Facility/Intermediate Care Facility	H5	ID

General Provider Information

NPI Number	:	1326166216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELMORE MEDICAL CENTER LTC

Provider Business Mailing Address
First Line	:	895 N 6TH E
Second Line	:
City	:	MTN HOME
State	:	ID
Zip	:	83647-2207
Country	:	US
Telephone Number	:	208-580-2661
Fax Number	:	208-587-8406

Provider Business Practice Location Address
First Line	:	895 N 6TH E
Second Line	:
City	:	MTN HOME
State	:	ID
Zip	:	83647-2207
Country	:	US
Telephone Number	:	208-580-2661
Fax Number	:	208-587-8406

Authorized Official
Title or Position	:	CFO
Name	:	MRS. TRICIA SENGER
Credential	:
Telephone Number	:	208-580-2661

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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Directions to “ELMORE MEDICAL CENTER LTC ” Practice Location

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