Provider Demographics
NPI:1093822074
Name:LATAH HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:LATAH HEALTH SERVICES, INC.
Other - Org Name:LATAH HEALTH THERAPY WORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEINMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-882-7586
Mailing Address - Street 1:510 W PALOUSE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-8901
Mailing Address - Country:US
Mailing Address - Phone:208-882-7586
Mailing Address - Fax:208-883-4473
Practice Address - Street 1:510 W PALOUSE RIVER DR
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-8901
Practice Address - Country:US
Practice Address - Phone:208-882-7586
Practice Address - Fax:208-883-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID136511Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER