Provider Demographics
NPI:1245757509
Name:CANYONS RETIREMENT LLC
Entity Type:Organization
Organization Name:CANYONS RETIREMENT LLC
Other - Org Name:CANYONS RETIREMENT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/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 1:4881 CLOVER DELL RD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-1805
Mailing Address - Country:US
Mailing Address - Phone:208-252-5902
Mailing Address - Fax:775-307-4049
Practice Address - Street 1:1215 CHENEY DR W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-1203
Practice Address - Country:US
Practice Address - Phone:208-358-9624
Practice Address - Fax:775-307-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness