Provider Demographics
NPI:1861500456
Name:OWYHEE HEALTH AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:OWYHEE HEALTH AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-337-3168
Mailing Address - Street 1:PO BOX A
Mailing Address - Street 2:
Mailing Address - City:HOMEDALE
Mailing Address - State:ID
Mailing Address - Zip Code:83628-2040
Mailing Address - Country:US
Mailing Address - Phone:208-337-3168
Mailing Address - Fax:208-337-4892
Practice Address - Street 1:108 W. OWYHEE AVE.
Practice Address - Street 2:
Practice Address - City:HOMEDALE
Practice Address - State:ID
Practice Address - Zip Code:83628
Practice Address - Country:US
Practice Address - Phone:208-337-3168
Practice Address - Fax:208-337-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID28314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
13-5087Medicare ID - Type Unspecified