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General NPI Number Information
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NPI Number | 1821713710
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Entity Type | Organization
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Legal Business Name | SPOKANE-IDAHO FALLS LLC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 3310 VALENCIA DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7502
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Country | US
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Telephone | 208-542-6200
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Fax | 208-552-6139
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Provider Business Mailing Address
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Address Line | 3310 VALENCIA DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7502
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Country | US
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Telephone | 208-542-6200
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Fax | 208-552-6139
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MACHELLE RAE BERGEMAN
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Credential |
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Telephone | 208-542-6200
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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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