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General NPI Number Information
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NPI Number | 1386354231
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Entity Type | Organization
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Legal Business Name | BLAINE OF CASCADIA LLC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 456 C ST
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City | BLAINE
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State | WA
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Zip | 98230-4238
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Country | US
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Telephone | 208-401-9600
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Fax | 208-314-0639
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Provider Business Mailing Address
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Address Line | 2205 E RIVERSIDE DR STE 100
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City | EAGLE
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State | ID
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Zip | 83616-7621
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Country | US
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Telephone | 208-401-9600
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Fax | 208-314-0639
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Authorized Official
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Title or Position | PRESIDENT
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Name | OWEN HAMMOND
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Credential |
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Telephone | 208-401-9600
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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 |
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License Number State |
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