Provider Demographics
NPI:1083800759
Name:EMMETT REHABILITATION AND HEALTHCARE, INC
Entity Type:Organization
Organization Name:EMMETT REHABILITATION AND HEALTHCARE, INC
Other - Org Name:EMMETT REHABILITATION AND HEALTHCARE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-375-9964
Mailing Address - Street 1:714 N BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-2725
Mailing Address - Country:US
Mailing Address - Phone:208-365-4425
Mailing Address - Fax:208-365-6989
Practice Address - Street 1:714 N BUTTE AVE
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-2725
Practice Address - Country:US
Practice Address - Phone:208-365-4425
Practice Address - Fax:208-365-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID19314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805218800Medicaid
ID135020Medicare Oscar/Certification