Healthcare Provider Details

I. General information

NPI: 1306094610
Provider Name (Legal Business Name): CHAROLAIS CARE III, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SPRAGUE AVE
BUHL ID
83316-1827
US

IV. Provider business mailing address

110 N 800 E
JEROME ID
83338-5724
US

V. Phone/Fax

Practice location:
  • Phone: 208-543-6401
  • Fax:
Mailing address:
  • Phone:
  • Fax: 208-904-4030

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: ANGELA DAWN PASQUALE
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-423-5591