Healthcare Provider Details

I. General information

NPI: 1760719934
Provider Name (Legal Business Name): SNF AMMON OPERATING COMPANY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 SOUTH 25TH EAST
AMMON ID
83406
US

IV. Provider business mailing address

2325 CORONADO ST
IDAHO FALLS ID
83404-7407
US

V. Phone/Fax

Practice location:
  • Phone: 208-528-4000
  • Fax: 208-557-2702
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SAM LONG
Title or Position: ADMINISTRATOR
Credential: LHCA
Phone: 208-520-6929