Provider Demographics
NPI:1508222480
Name:NORTHERN IDAHO ADVANCED CARE HOSPITAL INC
Entity Type:Organization
Organization Name:NORTHERN IDAHO ADVANCED CARE HOSPITAL INC
Other - Org Name:NIACH PHYSICIAN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-216-2299
Mailing Address - Street 1:1024 N GALLOWAY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2434
Mailing Address - Country:US
Mailing Address - Phone:972-216-2299
Mailing Address - Fax:
Practice Address - Street 1:600 N CECIL RD
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6200
Practice Address - Country:US
Practice Address - Phone:208-262-2800
Practice Address - Fax:208-262-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty