Healthcare Provider Details

I. General information

NPI: 1144719204
Provider Name (Legal Business Name): SAWTOOTH HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SHANAFELT ST
SALMON ID
83467-4261
US

IV. Provider business mailing address

600 SHANAFELT ST
SALMON ID
83467-4261
US

V. Phone/Fax

Practice location:
  • Phone: 208-756-8391
  • Fax: 208-756-8398
Mailing address:
  • Phone: 208-756-8391
  • Fax: 208-756-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249