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General NPI Number Information
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NPI Number | 1285624064
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Entity Type | Organization
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Legal Business Name | DIVISION OF VETERANS SERVICES
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 1957 ALVIN RICKEN DR
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City | POCATELLO
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State | ID
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Zip | 83201-2727
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Country | US
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Telephone | 208-236-6340
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Fax | 208-236-6343
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Provider Business Mailing Address
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Address Line | 1957 ALVIN RICKEN DR
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City | POCATELLO
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State | ID
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Zip | 83201-2727
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Country | US
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Telephone | 208-236-6340
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Fax | 208-236-6343
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Authorized Official
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Title or Position | DEPUTY CHIEF ADMINISTRATOR
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Name | TRACY SCHANER
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Credential |
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Telephone | 208-780-1320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 92
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License Number State | ID
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