Provider Demographics
NPI:1659723773
Name:OROFINO RETIREMENT PROPERTIES INC
Entity Type:Organization
Organization Name:OROFINO RETIREMENT PROPERTIES INC
Other - Org Name:BROOKSIDE LANDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MHSM
Authorized Official - Phone:208-476-2000
Mailing Address - Street 1:431 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-9516
Mailing Address - Country:US
Mailing Address - Phone:208-476-2000
Mailing Address - Fax:208-476-7748
Practice Address - Street 1:431 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9516
Practice Address - Country:US
Practice Address - Phone:208-476-2000
Practice Address - Fax:208-476-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC680310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8059959Medicaid