ETOSHA ASSISTED LIVING, INC (NPI# 1407462906) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407462906 |
| Entity Type | Organization |
| Organization Name | ETOSHA ASSISTED LIVING, INC |
| Practice Address |
243 N 300 E Rupert ID 83350-9491 |
| Practice Telephone | 2084363332 |
| Practice Fax Number | 2084361289 |
| Mailing Telephone | 5305100283 |
| Mailing Fax Number | 2084361289 |
| Enumeration Date | 2020-09-20 |
| Last Update Date | 2020-09-20 |
| Authorized Official Name | MRS. DEBORAH O COVEY (OWNER, DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 5305100283 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Street Address |
243 N 300 E |
| City | RUPERT |
| State | ID |
| Zip Code | 83350-9491 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417349515 | Robbie Joe Carroll | Registered Nurse | 1024 8th Street, Family Health Services, Rupert, ID 83350 | 2015-02-26 |
| 1285921643 | Duane Broderick | Counselor | 2311 Parke Ave., Ste. 8, Burley, ID 83350 | 2011-07-06 |
| 1598798282 | Kerry W Saurey | Family Medicine | 1218 9th St, Ste 7, Rupert, ID 83350 | 2006-07-08 |
| 1093761694 | Family Health Services Corporation | Dental Hygienist | 402 6th St, Rupert, ID 83350 | 2006-05-25 |
| 1376531004 | Jeffrey Scott Swenson | Family Medicine | 1308 8th St Ste 1, Rupert, ID 83350 | 2005-10-06 |
| 1205312774 | Shawna M Mccaffrey | Nurse Practitioner | 1308 8th St, Rupert, ID 83350 | 2018-07-17 |
| 1386872810 | Brian R Muir | Family Medicine | 1308 8th St Ste 1, Rupert, ID 83350 | 2009-06-23 |
| 1083816334 | Cameron Mchan | Nurse Practitioner | 1308 8th St Ste 1, Rupert, ID 83350 | 2007-05-31 |
| 1134225956 | Margo Saunders | Specialist | 1308 8th St Ste 1, Rupert, ID 83350 | 2006-09-16 |
| 1619900305 | Don C Pates | Family Medicine | 1218 9th St, Ste 7, Rupert, ID 83350 | 2006-07-08 |
| Find all providers in zip 83350 | ||||
| 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 |
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| 1548886963 | Diamond View Care Properties, LLC | Assisted Living Facility | 3570 E Amity Rd, Meridian, ID 83642-7014 | 2020-06-22 |
| 1619593068 | Frontier Management, LLC | Assisted Living Facility | 10250 W Smoke Ranch Dr, Boise, ID 83709-1467 | 2020-06-22 |
| 1174149991 | Rsl Renaissance, LLC | Assisted Living Facility | 2772 W Avante Loop, Coeur D Alene, ID 83815-0333 | 2020-06-17 |
| 1891319141 | Grace At Caldwell LLC | Assisted Living Facility | 518 N 21st Ave, Caldwell, ID 83605-4368 | 2020-06-02 |
| 1790309045 | Grace At Fairview Lakes LLC | Assisted Living Facility | 1960 N Lakes Pl, Meridian, ID 83646-5939 | 2020-06-02 |
| 1164046413 | Grace Memory Care At State Street LLC | Assisted Living Facility | 9779 W State St, Boise, ID 83714-1638 | 2020-06-02 |
| 1356965693 | Grace At State Street LLC | Assisted Living Facility | 9995 W State St, Boise, ID 83714-1636 | 2020-06-02 |
| 1336763689 | Grace LLC | Assisted Living Facility | 1610 Sunnyridge Rd, Nampa, ID 83686-7401 | 2020-06-02 |
| 1447874797 | Grace At Englefield Green LLC | Assisted Living Facility | 250 S Allumbaugh Way, Boise, ID 83709-5624 | 2020-06-02 |
| 1760002869 | New Beginnings Residential Care Facility LLC | Assisted Living Facility | 2105 Avocet Dr, Ammon, ID 83406-6606 | 2020-04-20 |
| Find all providers with the same taxonomy | ||||
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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.