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General NPI Number Information
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NPI Number | 1760719934
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Entity Type | Organization
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Legal Business Name | SNF AMMON OPERATING COMPANY LLC.
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 3909 SOUTH 25TH EAST
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City | AMMON
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State | ID
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Zip | 83406
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Country | US
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Telephone | 208-528-4000
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Fax | 208-557-2702
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Provider Business Mailing Address
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Address Line | 2325 CORONADO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SAM LONG
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Credential | LHCA
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Telephone | 208-520-6929
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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 |
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License Number State |
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