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General NPI Number Information
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NPI Number | 1427929736
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Entity Type | Organization
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Legal Business Name | SH1 MIDSTATE MGMT LLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 1367 LOCUST ST N
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City | TWIN FALLS
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State | ID
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Zip | 83301-3477
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Country | US
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Telephone | 208-735-0700
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Fax | 208-735-0900
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Provider Business Mailing Address
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Address Line | 5101 NE 82ND AVE STE 200
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City | VANCOUVER
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State | WA
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Zip | 98662-6343
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Country | US
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Telephone | 360-254-9442
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Fax | 360-254-1770
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Authorized Official
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Title or Position | DIRECTOR OF LICENSING
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Name | TERRI BAKER
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Credential |
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Telephone | 564-203-3620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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