Healthcare Provider Details

I. General information

NPI: 1568972016
Provider Name (Legal Business Name): ETROS LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E DALTON AVE
COEUR D ALENE ID
83815-9338
US

IV. Provider business mailing address

2986 N GRAND FIR DR
COEUR D ALENE ID
83815-6253
US

V. Phone/Fax

Practice location:
  • Phone: 208-665-2100
  • Fax: 208-665-9250
Mailing address:
  • Phone: 845-248-4554
  • 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 Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMBER WILLIAMS
Title or Position: CEO
Credential:
Phone: 845-248-4554