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General NPI Number Information
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NPI Number | 1629144274
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Entity Type | Organization
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Legal Business Name | ST JOSEPH SNF UNIT
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 415 6TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2431
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Country | US
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Telephone | 208-799-5200
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Fax | 208-799-5554
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Provider Business Mailing Address
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Address Line | PO BOX 816
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City | LEWISTON
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State | ID
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Zip | 83501-0816
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Country | US
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Telephone | 208-799-5200
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Fax | 208-799-5554
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS SERVICES
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Name | MS. SUSAN COLBURN
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Credential |
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Telephone | 208-799-5200
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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 | H57
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License Number State | ID
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