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General NPI Number Information
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NPI Number | 1104599901
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Entity Type | Organization
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Legal Business Name | OHANA NAMPA OPERATIONS, LLC
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 1355 S EDGEWATER CIR
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City | NAMPA
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State | ID
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Zip | 83686-6085
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Country | US
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Telephone | 503-250-3825
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 988
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-0109
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Country | US
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Telephone | 503-250-3825
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW HILTY
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Credential |
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Telephone | 503-250-3825
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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 |
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License Number State |
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