Provider Demographics
NPI:1750567590
Name:BACK TO BASIC LIVING RES.HAB.
Entity type:Organization
Organization Name:BACK TO BASIC LIVING RES.HAB.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAMETT
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATION
Authorized Official - Phone:208-736-1856
Mailing Address - Street 1:150 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5548
Mailing Address - Country:US
Mailing Address - Phone:208-735-8654
Mailing Address - Fax:208-735-8691
Practice Address - Street 1:150 ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5548
Practice Address - Country:US
Practice Address - Phone:208-735-8654
Practice Address - Fax:208-735-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care