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General NPI Number Information
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NPI Number | 1720950090
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Entity Type | Organization
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Legal Business Name | CORALVITA BOISE, LLC
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 6651 W FRANKLIN RD
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City | BOISE
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State | ID
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Zip | 83709-0914
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Country | US
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Telephone | 208-459-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 400 LAS COLINAS BLVD E
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City | IRVING
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State | TX
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Zip | 75039-5579
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Country | US
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Telephone | 972-567-4932
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ANIS SABETI
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Credential |
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Telephone | 972-567-4932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number |
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License Number State |
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