Healthcare Provider Details

I. General information

NPI: 1497617740
Provider Name (Legal Business Name): EMMETT OF OLYMPUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 S JOHNS AVE
EMMETT ID
83617-3699
US

IV. Provider business mailing address

1013 S JOHNS AVE
EMMETT ID
83617-3699
US

V. Phone/Fax

Practice location:
  • Phone: 208-365-1122
  • Fax:
Mailing address:
  • Phone: 208-401-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: OWEN C HAMMOND
Title or Position: PRESIDENT AND PRINCIPAL
Credential:
Phone: 208-401-9600