NPI 1316063787

State of Idaho

Organisation Intellectual Disabilities Intermediate Care Facility Nampa, ID

Practice location

Address: 1660 11th Ave N, Nampa, ID 83687-5000
Phone: (208) 442-2812
Fax: (208) 467-5978

Authorised official

Name: Sue Broetje
Title: Administrative Director
Phone: (208) 442-2812

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence 01 (ID)

Other Intermediate Care Facility, Intellectual Disabilities providers in Idaho →

Registry record

NPI: 1316063787
Entity type: Organization
NPI issued: 21 Mar 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.