Provider Demographics
NPI:1639406481
Name:ARROWROCK ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:ARROWROCK ASSISTED LIVING LLC
Other - Org Name:BEE HIVE HOMES OF MERIDIAN/CREST WOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-629-4644
Mailing Address - Street 1:1448 W CREST WOOD DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2498
Mailing Address - Country:US
Mailing Address - Phone:208-629-4644
Mailing Address - Fax:208-629-4642
Practice Address - Street 1:1448 W CREST WOOD DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2498
Practice Address - Country:US
Practice Address - Phone:208-629-4644
Practice Address - Fax:208-629-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC-975310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808491000Medicaid