Provider Demographics
NPI:1871042663
Name:AHC OF LEWISTON, LLC
Entity Type:Organization
Organization Name:AHC OF LEWISTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-670-5700
Mailing Address - Street 1:215 N WHITLEY DR STE 3
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2706
Mailing Address - Country:US
Mailing Address - Phone:208-452-6392
Mailing Address - Fax:
Practice Address - Street 1:2852 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4719
Practice Address - Country:US
Practice Address - Phone:208-748-7700
Practice Address - Fax:208-748-7750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-22
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility