Provider Demographics
NPI:1104360429
Name:SWAN FALLS ASSISTED LIVING
Entity Type:Organization
Organization Name:SWAN FALLS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:V
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-221-0481
Mailing Address - Street 1:194 W WHITE WAY
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-2989
Mailing Address - Country:US
Mailing Address - Phone:208-922-3536
Mailing Address - Fax:208-922-3538
Practice Address - Street 1:194 W WHITE WAY
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-2989
Practice Address - Country:US
Practice Address - Phone:208-922-3536
Practice Address - Fax:208-922-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC-1131310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDRC-1131Medicaid