Healthcare Provider Details

I. General information

NPI: 1720317761
Provider Name (Legal Business Name): JRT HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
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: 208-677-9814
Mailing address:
  • Phone: 208-677-3073
  • Fax: 208-677-9814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249