Healthcare Provider Details

I. General information

NPI: 1912157090
Provider Name (Legal Business Name): CHAROLAIS CARE II, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 POLK ST E
KIMBERLY ID
83341-1618
US

IV. Provider business mailing address

500 POLK ST E
KIMBERLY ID
83341-1618
US

V. Phone/Fax

Practice location:
  • Phone: 208-423-5591
  • Fax: 208-423-5651
Mailing address:
  • Phone: 208-423-5591
  • Fax: 208-423-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number17
License Number StateID

VIII. Authorized Official

Name: ANGELA PASQUALE
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-423-5591