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NPI Code Detail

MEDICARE: PAYETTE OF CASCADIA, LLC

MEDICARE: PAYETTE OF CASCADIA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1235683806
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAYETTE OF CASCADIA, LLC
Provider Business Mailing Address
First Line : 408 S EAGLE RD
Second Line : SUITE 205
City : EAGLE
State : ID
Zip : 83616
Country : US
Telephone Number : 949-416-6633
Fax Number : 844-362-3862
Provider Business Practice Location Address
First Line : 1019 3RD AVENUE SOUTH
Second Line :
City : PAYETTE
State : ID
Zip : 83661-2832
Country : US
Telephone Number : 208-678-9474
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : OWEN HAMMOND
Credential :
Telephone Number : 208-401-9600
Provider Enumeration Date : 08/11/2016
Last Update Date : 05/24/2024

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Directions to “PAYETTE OF CASCADIA, LLC ” Practice Location

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