Provider Demographics
NPI:1811291602
Name:PAYETTE SENIOR CENTER
Entity type:Organization
Organization Name:PAYETTE SENIOR CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST. HEAD OF BOARD
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-642-4223
Mailing Address - Street 1:137 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-2521
Mailing Address - Country:US
Mailing Address - Phone:208-642-4223
Mailing Address - Fax:
Practice Address - Street 1:137 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2521
Practice Address - Country:US
Practice Address - Phone:208-642-4223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care