=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619605136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVISION OF VETERANS SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2022
-----------------------------------------------------
Last Update Date | 10/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 PLEASANT VIEW RD. STE: 101
-----------------------------------------------------
City | POST FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-415-3430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 590 PLEASANT VIEW RD. STE: 101
-----------------------------------------------------
City | POST FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-415-3430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEPUTY CHIEF ADMINISTRATOR
-----------------------------------------------------
Name | TRACY SCHANER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-780-1320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------