Healthcare Provider Details

I. General information

NPI: 1659368801
Provider Name (Legal Business Name): DISCOVERY CARE CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/18/2007
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 TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberRC# 594
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF# 90
License Number StateID

VIII. Authorized Official

Name: MRS. DAWN L BROWN
Title or Position: BILLER
Credential:
Phone: 208-375-9964