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General NPI Number Information
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NPI Number | 1912627654
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Entity Type | Organization
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Legal Business Name | SPRING GARDENS MERIDIAN OPCO LLC
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 1180 W OVERLAND RD
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City | MERIDIAN
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State | ID
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Zip | 83642-6513
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Country | US
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Telephone | 208-605-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 N ARBOLEDA STE 215
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City | MESA
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State | AZ
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Zip | 85213-3217
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Country | US
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Telephone | 480-244-9173
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | CANDICE FINE
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Credential |
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Telephone | 480-244-9173
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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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