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General NPI Number Information
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NPI Number | 1013459882
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Entity Type | Organization
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Legal Business Name | TAMBREE MEADOWS ASSISTED LIVING
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Dates
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Enumeration Date | 11/10/2016
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 3550 POTOMAC WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4950
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Country | US
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Telephone | 208-522-1922
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Fax | 775-307-4049
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Provider Business Mailing Address
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Address Line | 3550 POTOMAC WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4950
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Country | US
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Telephone | 208-522-1922
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Fax | 775-307-4049
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Authorized Official
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Title or Position | CEO
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Name | TROY V BELL
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Credential |
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Telephone | 208-221-0481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | RC-1129
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License Number State | ID
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