1649547670 NPI number — COEUR D'ALENE PARTNERS, LLC DBA CREEKSIDE INN ASSISTED LIVING ALZ COMM

Table of content: (NPI 1649547670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649547670 NPI number — COEUR D'ALENE PARTNERS, LLC DBA CREEKSIDE INN ASSISTED LIVING ALZ COMM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COEUR D'ALENE PARTNERS, LLC DBA CREEKSIDE INN ASSISTED LIVING ALZ COMM
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1649547670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 MARKET ST NE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-1008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 E KATHLEEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83815-9812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-665-2444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KOELSCH
Authorized Official First Name:
EMMETT
Authorized Official Middle Name:
AARON
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
360-867-1900

Provider Taxonomy Codes

  • Taxonomy code: 311500000X , with the licence number:  RC-954 , 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)





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