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General NPI Number Information
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NPI Number | 1376674622
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Entity Type | Organization
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Legal Business Name | SPRING CREEK IDAHO, LLC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 175 E CALDERWOOD DR
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City | MERIDIAN
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State | ID
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Zip | 83642-7482
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Country | US
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Telephone | 208-884-6199
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Fax | 208-639-3419
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Provider Business Mailing Address
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Address Line | 253 E CALDERWOOD DR # E
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City | MERIDIAN
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State | ID
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Zip | 83642-7500
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Country | US
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Telephone | 208-855-5005
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Fax | 208-855-5034
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Authorized Official
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Title or Position | BOOKKEEPER
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Name | VIRGINIA THORNLEY
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Credential |
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Telephone | 208-855-5005
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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 |
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License Number State | ID
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