Provider Demographics
NPI:1629144274
Name:ST JOSEPH SNF UNIT
Entity Type:Organization
Organization Name:ST JOSEPH SNF UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-799-5200
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0816
Mailing Address - Country:US
Mailing Address - Phone:208-799-5200
Mailing Address - Fax:208-799-5554
Practice Address - Street 1:415 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2431
Practice Address - Country:US
Practice Address - Phone:208-799-5200
Practice Address - Fax:208-799-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDH57314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID02774OtherTRANSITIONAL CARE UNIT
ID135121Medicare ID - Type UnspecifiedTRANSITIONAL CARE UNIT