Provider Demographics
NPI:1326409798
Name:AHC OF COEUR D ALENE LLC
Entity Type:Organization
Organization Name:AHC OF COEUR D ALENE LLC
Other - Org Name:ADVANCED HEALTH CARE OF COEUR D' ALENE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OXNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9860
Mailing Address - Street 1:1578 W RIVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5760
Mailing Address - Country:US
Mailing Address - Phone:208-769-0400
Mailing Address - Fax:
Practice Address - Street 1:1578 W RIVERSTONE DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-769-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW AHC HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility