Provider Demographics
NPI:1033814363
Name:MOUNTAIN SPRINGS ASSISTED LIVING CENTER LLC
Entity Type:Organization
Organization Name:MOUNTAIN SPRINGS ASSISTED LIVING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-448-1890
Mailing Address - Street 1:3254 SPIRIT LAKE CUT OFF
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83869-9376
Mailing Address - Country:US
Mailing Address - Phone:208-263-2273
Mailing Address - Fax:
Practice Address - Street 1:3254 SPIRIT LAKE CUT OFF
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:ID
Practice Address - Zip Code:83869-9376
Practice Address - Country:US
Practice Address - Phone:208-263-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based