| Organization Name: | ST LUKES JEROME LTD |
| NPI Number: | 1356380893 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES ANGLE (CEO) |
| Mailing Address: | 709 N Lincoln Ave Jerome |
| State: | ID US |
| Postal Code: | 833381851 |
| Phone Number: | 2083244301 |
| Fax Number: | 2083243878 |
| NPI Enumeration Date: | 06/06/2006 |
| NPI Last Update Date: | 05/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/03/2015 |
| NPI Reactivation Date: | 05/07/2015 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 275N00000X |
| License Number: | 08 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Hospital Units |
| Taxonomy Classification: | Medicare Defined Swing Bed Unit |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit. |