Healthcare Provider Details

I. General information

NPI: 1902856727
Provider Name (Legal Business Name): ST BENEDICTS FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 N LINCOLN AVE
JEROME ID
83338-1851
US

IV. Provider business mailing address

709 N LINCOLN AVE
JEROME ID
83338-1851
US

V. Phone/Fax

Practice location:
  • Phone: 208-324-0422
  • Fax: 208-324-3878
Mailing address:
  • Phone: 208-324-0422
  • Fax: 208-324-3878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH8
License Number StateID

VIII. Authorized Official

Name: MS. JILL L HOWELL
Title or Position: ASSISTANT ADMINISTRATOR
Credential: RN-NHA
Phone: 208-324-0422