Healthcare Provider Details

I. General information

NPI: 1548489735
Provider Name (Legal Business Name): SAINT ALPHONSUS REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 E PLAZA DR #105
EAGLE ID
83616
US

IV. Provider business mailing address

901 N CURTIS RD #204
BOISE ID
83706-1338
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-6934
  • Fax: 208-367-2674
Mailing address:
  • Phone: 208-367-6934
  • Fax: 208-367-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number2
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code2278P1005X
TaxonomyPulmonary Rehabilitation Certified Respiratory Therapist
License Number2
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2
License Number StateID
# 7
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2
License Number StateID

VIII. Authorized Official

Name: BRIAN LANNIE CHECKETTS
Title or Position: CFO
Credential:
Phone: 208-367-7347