Provider Demographics
NPI:1821713710
Name:SPOKANE-IDAHO FALLS LLC
Entity Type:Organization
Organization Name:SPOKANE-IDAHO FALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MACHELLE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BERGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-542-6200
Mailing Address - Street 1:3310 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7502
Mailing Address - Country:US
Mailing Address - Phone:208-542-6200
Mailing Address - Fax:208-552-6139
Practice Address - Street 1:3310 VALENCIA DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7502
Practice Address - Country:US
Practice Address - Phone:208-542-6200
Practice Address - Fax:208-552-6139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IDFALLS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility