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General NPI Number Information
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NPI Number | 1730815812
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Entity Type | Organization
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Legal Business Name | BLACKFOOT OPERATIONS LLC
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 898 S MERIDIAN ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-2660
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Country | US
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Telephone | 208-782-1478
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Fax |
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Provider Business Mailing Address
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Address Line | 12500 SE 2ND CIR STE 205
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City | VANCOUVER
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State | WA
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Zip | 98684-6030
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Country | US
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Telephone | 360-882-4500
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | PAUL DENDY
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Credential |
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Telephone | 360-882-4500
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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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