Healthcare Provider Details

I. General information

NPI: 1780638213
Provider Name (Legal Business Name): SANDPOINT MEDICAL INVESTORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N DIVISION AVE
SANDPOINT ID
83864-2148
US

IV. Provider business mailing address

3001 KEITH ST NW
CLEVELAND TN
37312-3713
US

V. Phone/Fax

Practice location:
  • Phone: 208-265-9299
  • Fax: 208-265-9710
Mailing address:
  • Phone: 423-473-5751
  • Fax: 423-339-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number80
License Number StateID

VIII. Authorized Official

Name: CINDY S. CROSS
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 423-473-5867