Healthcare Provider Details

I. General information

NPI: 1629144274
Provider Name (Legal Business Name): ST JOSEPH SNF UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501-2431
US

IV. Provider business mailing address

PO BOX 816
LEWISTON ID
83501-0816
US

V. Phone/Fax

Practice location:
  • Phone: 208-799-5200
  • Fax: 208-799-5554
Mailing address:
  • Phone: 208-799-5200
  • Fax: 208-799-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH57
License Number StateID

VIII. Authorized Official

Name: MS. SUSAN COLBURN
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 208-799-5200