Provider Demographics
NPI:1396427266
Name:MAKENNA FARMS LLC
Entity type:Organization
Organization Name:MAKENNA FARMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAKENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:208-780-9998
Mailing Address - Street 1:3610 W LAMONT RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6430
Mailing Address - Country:US
Mailing Address - Phone:208-407-4846
Mailing Address - Fax:
Practice Address - Street 1:3610 W LAMONT RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6430
Practice Address - Country:US
Practice Address - Phone:208-407-4846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility