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General NPI Number Information
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NPI Number | 1750567590
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Entity Type | Organization
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Legal Business Name | BACK TO BASIC LIVING RES.HAB.
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 150 ATLANTIC ST
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City | TWIN FALLS
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State | ID
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Zip | 83301-5548
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Country | US
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Telephone | 208-735-8654
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Fax | 208-735-8691
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Provider Business Mailing Address
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Address Line | 150 ATLANTIC ST
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City | TWIN FALLS
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State | ID
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Zip | 83301-5548
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Country | US
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Telephone | 208-735-8654
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Fax | 208-735-8691
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Authorized Official
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Title or Position | ADMINISTRATO/OWNER
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Name | MRS. RHONDA LYNN HAMETT
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Credential | ADMINISTRATION
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Telephone | 208-736-1856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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