Healthcare Provider Details

I. General information

NPI: 1477260636
Provider Name (Legal Business Name): BENEVOLENT ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 07/01/2023
Certification Date: 07/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9976 W PATTIE DR
BOISE ID
83704-2900
US

IV. Provider business mailing address

1532 W POWDER CT
EAGLE ID
83616-4876
US

V. Phone/Fax

Practice location:
  • Phone: 208-813-6449
  • Fax: 208-813-6462
Mailing address:
  • Phone: 986-888-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DARRYL RAY RUFFNER
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 208-813-6449