Provider Demographics
NPI:1457419418
Name:HAIGHT, ANITA ROSE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:ROSE
Last Name:HAIGHT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2564 ELIZABETH BLVD
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7508
Mailing Address - Country:US
Mailing Address - Phone:208-735-4160
Mailing Address - Fax:208-735-2426
Practice Address - Street 1:2564 ELIZABETH BLVD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7508
Practice Address - Country:US
Practice Address - Phone:208-735-4160
Practice Address - Fax:208-735-2426
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID50051311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8057857Medicaid