Healthcare Provider Details

I. General information

NPI: 1427929736
Provider Name (Legal Business Name): SH1 MIDSTATE MGMT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 LOCUST ST N
TWIN FALLS ID
83301-3477
US

IV. Provider business mailing address

5101 NE 82ND AVE STE 200
VANCOUVER WA
98662-6343
US

V. Phone/Fax

Practice location:
  • Phone: 208-735-0700
  • Fax: 208-735-0900
Mailing address:
  • Phone: 360-254-9442
  • Fax: 360-254-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: TERRI BAKER
Title or Position: DIRECTOR OF LICENSING
Credential:
Phone: 564-203-3620