Healthcare Provider Details

I. General information

NPI: 1013459882
Provider Name (Legal Business Name): TAMBREE MEADOWS ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 POTOMAC WAY
IDAHO FALLS ID
83404-4950
US

IV. Provider business mailing address

3550 POTOMAC WAY
IDAHO FALLS ID
83404-4950
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-1922
  • Fax: 775-307-4049
Mailing address:
  • Phone: 208-522-1922
  • Fax: 775-307-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberRC-1129
License Number StateID

VIII. Authorized Official

Name: TROY V BELL
Title or Position: CEO
Credential:
Phone: 208-221-0481