Provider Demographics
NPI:1881433852
Name:TRINITY ASSISTED LIVING OF IDAHO, INC
Entity type:Organization
Organization Name:TRINITY ASSISTED LIVING OF IDAHO, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELISHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-409-1090
Mailing Address - Street 1:465 CABARTON RD
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:ID
Mailing Address - Zip Code:83611-5004
Mailing Address - Country:US
Mailing Address - Phone:208-409-1090
Mailing Address - Fax:
Practice Address - Street 1:12423 W LEWIS AND CLARK DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0014
Practice Address - Country:US
Practice Address - Phone:208-810-3843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY ASSISTED LIVING OF IDAHO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-21
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances