Healthcare Provider Details

I. General information

NPI: 1871200154
Provider Name (Legal Business Name): CASCADES AT LINCOLN COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E 4TH ST
SHOSHONE ID
83352-5380
US

IV. Provider business mailing address

5314 N RIVER RUN DRIVE STE 140
PROVO UT
84604
US

V. Phone/Fax

Practice location:
  • Phone: 208-886-2228
  • Fax: 208-969-9107
Mailing address:
  • Phone: 801-426-4905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DARIN MCSPADDEN
Title or Position: MANAGER/CEO
Credential:
Phone: 801-426-4905