Provider Demographics
NPI:1326166216
Name:ELMORE MEDICAL CENTER LTC
Entity Type:Organization
Organization Name:ELMORE MEDICAL CENTER LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-580-2661
Mailing Address - Street 1:895 N 6TH E
Mailing Address - Street 2:
Mailing Address - City:MTN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2207
Mailing Address - Country:US
Mailing Address - Phone:208-580-2661
Mailing Address - Fax:208-587-8406
Practice Address - Street 1:895 N 6TH E
Practice Address - Street 2:
Practice Address - City:MTN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2207
Practice Address - Country:US
Practice Address - Phone:208-580-2661
Practice Address - Fax:208-587-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDH5313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility