1538567532 NPI number — CHAROLAIS CARE VIII, INC

Table of content: (NPI 1538567532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538567532 NPI number — CHAROLAIS CARE VIII, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAROLAIS CARE VIII, INC
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:
1538567532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 ADDISON AVE W
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
TWIN FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83301-5851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-736-1050
Provider Business Mailing Address Fax Number:
208-733-2367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 ADDISON AVE W
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-5851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-736-1050
Provider Business Practice Location Address Fax Number:
208-733-2367
Provider Enumeration Date:
12/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PASQUALE
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
208-736-1050

Provider Taxonomy Codes

  • Taxonomy code: 3245S0500X , with the licence number:  38517 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38517 . This is a "STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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