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General NPI Number Information
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NPI Number | 1003803024
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Entity Type | Organization
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Legal Business Name | NORTHWEST BEC CORP DBA BURLEY CARE CENTER
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 1729 MILLER AVE
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City | BURLEY
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State | ID
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Zip | 83318-2338
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Country | US
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Telephone | 208-678-9474
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Fax | 208-678-3727
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Provider Business Mailing Address
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Address Line | PO BOX 1224
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City | BURLEY
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State | ID
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Zip | 83318-0830
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Country | US
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Telephone | 208-678-9474
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Fax | 208-678-3727
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RICHARD L. KEDDINGTON
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Credential | NHA
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Telephone | 208-678-9474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 42
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License Number State | ID
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