=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912418229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAMPA WEST OF CASCADIA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2017
-----------------------------------------------------
Last Update Date | 05/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 N HORTON ST
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83651-6541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-466-9292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 408 S EAGLE RD STE 205
-----------------------------------------------------
City | EAGLE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83616-6079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-401-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. OWEN HAMMOND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-401-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------