Organization Name: | EDGEWOOD SPRING CREEK SODA SPRINGS, LLC |
NPI Number: | 1841575982 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HEATHER C KORTAN (FINANCIAL ANAYLSIS) |
Mailing Address: | 425 S Spring Creek Dr Soda Springs |
State: | ID US |
Postal Code: | 832761628 |
Phone Number: | 2085470257 |
Fax Number: | 2085474879 |
NPI Enumeration Date: | 10/20/2011 |
NPI Last Update Date: | 10/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | RC-1010 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |