1265782189 NPI number — SNF BOISE OPERATING COMPANY LLC

Table of content: (NPI 1265782189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265782189 NPI number — SNF BOISE OPERATING COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SNF BOISE OPERATING COMPANY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265782189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
598 W 900 S STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODS CROSS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84010-8195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
18-397-4697
Provider Business Mailing Address Fax Number:
801-296-9117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3550 W AMERICANA TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83706-4728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-615-4940
Provider Business Practice Location Address Fax Number:
208-472-6950
Provider Enumeration Date:
09/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SNOWBALL
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
GOVERNING BODY CHAIR
Authorized Official Telephone Number:
801-397-4000

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 66 . This is a "SNF OPERATING LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".