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General NPI Number Information
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NPI Number | 1528950805
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Entity Type | Organization
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Legal Business Name | TWIN FALLS CHARDONNAY LLC
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Dates
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Enumeration Date | 07/19/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 1045 CARRIAGE LN
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City | TWIN FALLS
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State | ID
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Zip | 83301-6751
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Country | US
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Telephone | 208-736-4608
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Fax |
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Provider Business Mailing Address
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Address Line | 4340 STONEBROOK LN
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | RICHARD BASCOM
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Credential |
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Telephone | 360-722-4062
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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 |
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