Healthcare Provider Details

I. General information

NPI: 1023079092
Provider Name (Legal Business Name): NORTHERN IDAHO ADVANCED CARE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N CECIL RD
POST FALLS ID
83854-6200
US

IV. Provider business mailing address

1024 N GALLOWAY AVE STE 102
MESQUITE TX
75149-2434
US

V. Phone/Fax

Practice location:
  • Phone: 208-262-2800
  • Fax: 550-892-2442
Mailing address:
  • Phone: 972-216-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number67
License Number StateID

VIII. Authorized Official

Name: DENISE KANN
Title or Position: VP & SECRETARY
Credential:
Phone: 602-432-2809