Healthcare Provider Details

I. General information

NPI: 1720217128
Provider Name (Legal Business Name): CHAROLAIS CARE VII INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MONTANA ST
GOODING ID
83330-1856
US

IV. Provider business mailing address

2043 E CENTER ST SUITE 212
POCATELLO ID
83201-3300
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-5601
  • Fax: 208-934-8154
Mailing address:
  • Phone: 208-233-4673
  • Fax: 208-233-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARLEEN WELLARD
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 208-221-2019