Healthcare Provider Details

I. General information

NPI: 1235683806
Provider Name (Legal Business Name): PAYETTE OF CASCADIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 3RD AVENUE SOUTH
PAYETTE ID
83661-2832
US

IV. Provider business mailing address

408 S EAGLE RD SUITE 205
EAGLE ID
83616
US

V. Phone/Fax

Practice location:
  • Phone: 208-678-9474
  • Fax:
Mailing address:
  • Phone: 949-416-6633
  • Fax: 844-362-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: OWEN HAMMOND
Title or Position: PRESIDENT
Credential:
Phone: 208-401-9600