Provider Demographics
NPI:1902856727
Name:ST BENEDICTS FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST BENEDICTS FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN-NHA
Authorized Official - Phone:208-324-0422
Mailing Address - Street 1:709 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-1851
Mailing Address - Country:US
Mailing Address - Phone:208-324-0422
Mailing Address - Fax:208-324-3878
Practice Address - Street 1:709 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-1851
Practice Address - Country:US
Practice Address - Phone:208-324-0422
Practice Address - Fax:208-324-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDH8314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID01339OtherBLUE CROSS OF IDAHO
ID135033Medicare ID - Type Unspecified