| NPI | 1659368801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN L BROWN Biller 208-375-9964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: ID SNF# 90) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: ID RC# 594) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2007-07-18 |