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NPI Code Detail

MEDICARE: CASSIA LONG TERM CARE, INC.

MEDICARE: CASSIA LONG TERM CARE, INC.
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 FacilityH20ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669469953
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASSIA LONG TERM CARE, INC.
Provider Business Mailing Address
First Line : 2303 PARK AVE
Second Line :
City : BURLEY
State : ID
Zip : 83318-2106
Country : US
Telephone Number : 208-677-3073
Fax Number : 208-677-3181
Provider Business Practice Location Address
First Line : 2303 PARK AVE
Second Line :
City : BURLEY
State : ID
Zip : 83318-2106
Country : US
Telephone Number : 208-677-3073
Fax Number : 208-677-3181
Authorized Official
Title or Position : ADMINISTRATOR
Name : SHAUNA L KRAUS
Credential : LNHA
Telephone Number : 208-677-3073
Provider Enumeration Date : 09/30/2005
Last Update Date : 09/11/2009

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