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General NPI Number Information
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NPI Number | 1245757509
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Entity Type | Organization
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Legal Business Name | CANYONS RETIREMENT LLC
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 08/28/2017
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Provider Practice Location Address
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Address Line | 1215 CHENEY DR W
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City | TWIN FALLS
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State | ID
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Zip | 83301-1203
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Country | US
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Telephone | 208-358-9624
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Fax | 775-307-4049
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Provider Business Mailing Address
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Address Line | 4881 CLOVER DELL RD
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City | CHUBBUCK
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State | ID
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Zip | 83202-1805
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Country | US
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Telephone | 208-252-5902
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Fax | 775-307-4049
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Authorized Official
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Title or Position | PRESIDENT/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 | 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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