Provider Demographics
NPI:1184866105
Name:SARAH CARE OF BOISE
Entity Type:Organization
Organization Name:SARAH CARE OF BOISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-313-2801
Mailing Address - Street 1:7957 N RIVERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4981
Mailing Address - Country:US
Mailing Address - Phone:208-529-8828
Mailing Address - Fax:888-836-8828
Practice Address - Street 1:1655 VINNELL ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-5138
Practice Address - Country:US
Practice Address - Phone:208-529-8828
Practice Address - Fax:888-836-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808088500Medicaid