Healthcare Provider Details

I. General information

NPI: 1669469953
Provider Name (Legal Business Name): CASSIA LONG TERM CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 PARK AVE
BURLEY ID
83318-2106
US

IV. Provider business mailing address

2303 PARK AVE
BURLEY ID
83318-2106
US

V. Phone/Fax

Practice location:
  • Phone: 208-677-3073
  • Fax: 208-677-3181
Mailing address:
  • Phone: 208-677-3073
  • Fax: 208-677-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH20
License Number StateID

VIII. Authorized Official

Name: SHAUNA L KRAUS
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 208-677-3073