Provider Demographics
NPI:1023079092
Name:NORTHERN IDAHO ADVANCED CARE HOSPITAL INC
Entity type:Organization
Organization Name:NORTHERN IDAHO ADVANCED CARE HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-216-2299
Mailing Address - Street 1:1024 N GALLOWAY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2434
Mailing Address - Country:US
Mailing Address - Phone:972-216-2299
Mailing Address - Fax:
Practice Address - Street 1:600 N CECIL RD
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6200
Practice Address - Country:US
Practice Address - Phone:208-262-2800
Practice Address - Fax:550-892-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID67282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID132001Medicare ID - Type UnspecifiedPROVIDER NUMBER