Healthcare Provider Details

I. General information

NPI: 1477816965
Provider Name (Legal Business Name): SAWTOOTH HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
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 TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateID

VIII. Authorized Official

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