Provider Demographics
NPI:1073382487
Name:SAWTOOTH SENIOR LIVING LLC
Entity Type:Organization
Organization Name:SAWTOOTH SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1400
Mailing Address - Street 1:1675 E RIVERSIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7473
Mailing Address - Country:US
Mailing Address - Phone:208-401-1048
Mailing Address - Fax:
Practice Address - Street 1:1675 E RIVERSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7473
Practice Address - Country:US
Practice Address - Phone:208-401-1048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility