Healthcare Provider Details

I. General information

NPI: 1184620791
Provider Name (Legal Business Name): ELMORE MEDICAL CENTER HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 N 6TH E
MOUNTAIN HOME ID
83647-2207
US

IV. Provider business mailing address

895 N 6TH E PO BOX 1270
MOUNTAIN HOME ID
83647-2207
US

V. Phone/Fax

Practice location:
  • Phone: 208-587-8401
  • Fax: 208-580-2685
Mailing address:
  • Phone: 208-587-8401
  • Fax: 208-580-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH5
License Number StateID

VIII. Authorized Official

Name: MRS. TRICIA SENGER
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 208-587-8401