Provider Demographics
NPI:1255469524
Name:YELLOWSTONE CARE CENTER, INC.
Entity Type:Organization
Organization Name:YELLOWSTONE CARE CENTER, INC.
Other - Org Name:DBA YELLOWSTONE GROUP HOMES - #4
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-362-5235
Mailing Address - Street 1:3155 RIVER RD S STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-9819
Mailing Address - Country:US
Mailing Address - Phone:503-362-5235
Mailing Address - Fax:503-585-3267
Practice Address - Street 1:370 HOLLOW DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-3481
Practice Address - Country:US
Practice Address - Phone:208-542-2993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities