Provider Demographics
NPI:1952614240
Name:M KNIGHT INC
Entity Type:Organization
Organization Name:M KNIGHT INC
Other - Org Name:CHARDONNAY ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-736-4808
Mailing Address - Street 1:1045 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6751
Mailing Address - Country:US
Mailing Address - Phone:208-736-4808
Mailing Address - Fax:208-736-4809
Practice Address - Street 1:1045 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6751
Practice Address - Country:US
Practice Address - Phone:208-736-4808
Practice Address - Fax:208-736-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC-961310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8082996Medicaid