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General NPI Number Information
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NPI Number | 1205975851
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH HOSPITAL, LLC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 415 6TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2431
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Country | US
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Telephone | 208-799-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 680 S 4TH ST LICENSE AND CERTIFICATION
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City | LOUISVILLE
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State | KY
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Zip | 40202-2407
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Country | US
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Telephone |
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Fax | 502-212-8481
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOHNETTA TRAYLOR
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Credential | PESC
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Telephone | 502-596-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State | ID
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