Healthcare Provider Details

I. General information

NPI: 1326954686
Provider Name (Legal Business Name): BOISE SH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1093 S HILTON ST
BOISE ID
83705-1971
US

IV. Provider business mailing address

560 1ST ST STE 104
LAKE OSWEGO OR
97034-3273
US

V. Phone/Fax

Practice location:
  • Phone: 208-345-4460
  • Fax:
Mailing address:
  • Phone: 971-804-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVEN BAE
Title or Position: VP OF OPS SUPPORT
Credential:
Phone: 971-804-4195