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General NPI Number Information
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NPI Number | 1215737127
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Entity Type | Organization
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Legal Business Name | SECURE HOUSING LLC
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 210 N IDAHO ST
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City | WENDELL
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State | ID
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Zip | 83355-5037
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Country | US
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Telephone | 208-221-4721
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Fax | 208-536-5570
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Provider Business Mailing Address
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Address Line | PO BOX 306
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City | WENDELL
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State | ID
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Zip | 83355-0306
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Country | US
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Telephone | 208-221-4721
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Fax | 208-536-5570
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SCOTT FRANKLIN BURPEE
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Credential | ALA
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Telephone | 208-221-4721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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