GRACE AT STATE STREET LLC (NPI# 1356965693) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356965693 |
| Entity Type | Organization |
| Organization Name | GRACE AT STATE STREET LLC |
| Practice Address |
9995 W State St Boise ID 83714-1636 |
| Mailing Address |
890 N Cole Rd Boise ID 83704-8638 |
| Practice Telephone | 2088533337 |
| Mailing Telephone | 2088533337 |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2020-06-02 |
| Authorized Official Name | LINDA HINES (OWNER) |
| Authorized Official Telephone | 2083421312 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | A0002183 | 05 |
| Street Address |
9995 W STATE ST |
| City | BOISE |
| State | ID |
| Zip Code | 83714-1636 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932683752 | Ikdo State Street LLC | Dentist | 9209 W State St, Garden City, ID 83714 | 2018-09-18 |
| 1437608007 | Carrie Boroughs Breaux | Ophthalmology | 5019 N Sawyer Ave, Garden City, ID 83714 | 2016-09-23 |
| 1841646007 | Alliance Medical Group, LLC | Family Medicine | 5601 W. Chinden Blvd., Garden City, ID 83714 | 2016-05-06 |
| 1134580467 | Rebecca Gillet | Physical Therapist | 6576 W Dufferin Ct, Boise, ID 83714 | 2016-03-15 |
| 1063816007 | Ingri Suzanne Koloski | Counselor | 8969 West Hepburn Lane, Garden City, ID 83714 | 2014-10-20 |
| 1679909329 | Anile Nina | Counselor | 5484 N Gary Lane, Boise, ID 83714 | 2013-09-25 |
| 1215360292 | William Blake Bybee | Dentist | 5833 W. Hidden Springs Dr., Boise, ID 83714 | 2013-08-14 |
| 1871833327 | Charmaine Read | Social Worker | 123 E. 44th St, Ste. A, Garden City, ID 83714 | 2013-02-20 |
| 1811206576 | Bennett Medical Services | Durable Medical Equipment & Medical Supplies | 5220 Sawyer Court, Suite D, Garden City, ID 83714 | 2010-09-29 |
| 1073780680 | Barry Lynn Williams | Pharmacist | 7020 W State Street, Boise, ID 83714 | 2008-05-13 |
| Find all providers in zip 83714 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619593068 | Frontier Management, LLC | Assisted Living Facility | 10250 W Smoke Ranch Dr, Boise, ID 83709-1467 | 2020-06-22 |
| 1164046413 | Grace Memory Care At State Street LLC | Assisted Living Facility | 9779 W State St, Boise, ID 83714-1638 | 2020-06-02 |
| 1447874797 | Grace At Englefield Green LLC | Assisted Living Facility | 250 S Allumbaugh Way, Boise, ID 83709-5624 | 2020-06-02 |
| 1942848502 | The Spaulding Home LLC | Assisted Living Facility | 1709 W Spaulding St, Boise, ID 83705-4223 | 2019-12-13 |
| 1023671435 | Edgewood Castle Hills LLC | Assisted Living Facility | 5955 W Castle Dr, Boise, ID 83703-3215 | 2019-04-22 |
| 1477016012 | Veranda At Barber Station LLC | Assisted Living Facility | 3266 E. Barber Valley Drive, Boise, ID 83712 | 2019-04-10 |
| 1114383577 | Edgewood Spring Creek Eagle Island LLC | Assisted Living Facility | 12426 W Explorer Dr Ste 220, Boise, ID 83713-1560 | 2016-01-14 |
| 1568843605 | Treasure Valley Senior Living, Inc. | Assisted Living Facility | 1777 S Curtis Rd, Boise, ID 83705-2708 | 2015-06-15 |
| 1083959902 | Brookdale Senior Living Communities, Inc. | Assisted Living Facility | 739 E Parkcenter Blvd, Boise, ID 83706-6511 | 2012-12-04 |
| 1821366998 | Bronco Senior Services | Assisted Living Facility | 1093 S Hilton St, Boise, ID 83705-1971 | 2011-12-05 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.