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General NPI Number Information
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NPI Number | 1942848502
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Entity Type | Organization
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Legal Business Name | THE SPAULDING HOME LLC
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 1709 W SPAULDING ST
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City | BOISE
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State | ID
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Zip | 83705-4223
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Country | US
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Telephone | 208-384-1393
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 W SPAULDING ST
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City | BOISE
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State | ID
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Zip | 83705-4223
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Country | US
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Telephone | 208-384-1393
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVE WAYNE VINSONHALER
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Credential |
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Telephone | 208-407-7237
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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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