Provider Demographics
NPI:1619360724
Name:CHAROLAIS CARE VIII, INC
Entity Type:Organization
Organization Name:CHAROLAIS CARE VIII, INC
Other - Org Name:SAWTOOTH BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PASQUALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-736-1050
Mailing Address - Street 1:650 ADDISON AVE W STE 300B
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5851
Mailing Address - Country:US
Mailing Address - Phone:208-736-1050
Mailing Address - Fax:208-733-2367
Practice Address - Street 1:650 ADDISON AVE W STE 300B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5851
Practice Address - Country:US
Practice Address - Phone:208-736-1050
Practice Address - Fax:208-733-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID63283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID571769OtherJOINT COMMISSION
ID63OtherSTATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
ID63OtherSTATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE