Healthcare Provider Details

I. General information

NPI: 1104360429
Provider Name (Legal Business Name): SWAN FALLS ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 W WHITE WAY
KUNA ID
83634-2989
US

IV. Provider business mailing address

194 W WHITE WAY
KUNA ID
83634-2989
US

V. Phone/Fax

Practice location:
  • Phone: 208-922-3536
  • Fax: 208-922-3538
Mailing address:
  • Phone: 208-922-3536
  • Fax: 208-922-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberRC-1131
License Number StateID

VIII. Authorized Official

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