Provider Demographics
NPI:1659368801
Name:DISCOVERY CARE CENTRE
Entity Type:Organization
Organization Name:DISCOVERY CARE CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-375-9964
Mailing Address - Street 1:600 SHANAFELT ST
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-4261
Mailing Address - Country:US
Mailing Address - Phone:208-756-8391
Mailing Address - Fax:208-756-8398
Practice Address - Street 1:600 SHANAFELT ST
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4261
Practice Address - Country:US
Practice Address - Phone:208-756-8391
Practice Address - Fax:208-756-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC# 594310400000X
IDSNF# 90314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID90OtherSTATE OF ID SNF LICENSE
IDRC#594OtherID ASSISTED LIVING LISC
IDRC#594OtherID ASSISTED LIVING LISC