Provider Demographics
NPI:1568972016
Name:ETROS LIVING, LLC
Entity Type:Organization
Organization Name:ETROS LIVING, LLC
Other - Org Name:OPUS LIVING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-248-4554
Mailing Address - Street 1:2986 N GRAND FIR DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-6253
Mailing Address - Country:US
Mailing Address - Phone:845-248-4554
Mailing Address - Fax:
Practice Address - Street 1:840 E DALTON AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9338
Practice Address - Country:US
Practice Address - Phone:208-665-2100
Practice Address - Fax:208-665-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDRC-1065OtherIDAHO DEPARTMENT OF HEALTH AND WELFARE RESIDENTIAL CARE FACILITY LICENSE
IDRC-1066OtherIDAHO DEPARTMENT OF HEALTH AND WELFARE RESIDENTIAL CARE FACILITY LICENSE
IDRC-1067OtherIDAHO DEPARTMENT OF HEALTH AND WELFARE RESIDENTIAL CARE FACILITY LICENSE