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General NPI Number Information
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NPI Number | 1134562648
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Entity Type | Organization
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Legal Business Name | SUNSET HOME ASSISTED LIVING, INC.
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 510920 HIGHWAY 95
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City | BONNERS FERRY
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State | ID
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Zip | 83805-5588
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Country | US
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Telephone | 208-267-0260
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Fax | 208-267-0263
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Provider Business Mailing Address
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Address Line | 510920 HIGHWAY 95
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City | BONNERS FERRY
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State | ID
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Zip | 83805-5588
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Country | US
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Telephone | 208-267-0260
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Fax | 208-267-0263
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NATHAN ISAAC
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Credential |
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Telephone | 208-267-0260
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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 1044
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License Number State | ID
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