Provider Demographics
NPI:1821366998
Name:BRONCO SENIOR SERVICES
Entity Type:Organization
Organization Name:BRONCO SENIOR SERVICES
Other - Org Name:HILLCREST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-257-2366
Mailing Address - Street 1:1093 S HILTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1971
Mailing Address - Country:US
Mailing Address - Phone:208-345-4460
Mailing Address - Fax:
Practice Address - Street 1:1093 S HILTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1971
Practice Address - Country:US
Practice Address - Phone:208-345-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC-998310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility