Gooding Rehab And Living Center

NPI 1023096757 - Intermediate Care Facility, Mental Illness - 310500000X

NPI Details
NPI 1023096757
Enumeration Date 01/03/2006
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 12 years ago
Authorized Information
Name STACY LYNN STACY
Position ADMINISTRATOR
Phone (208) 934-5601
Fax (208) 934-8154
Practice Location
1220 MONTANA ST
GOODING ID, 83330-1856, US
Phone (208) 934-5601
Fax (208) 934-8154
Business Location
1220 MONTANA ST
GOODING ID, 83330-1856, US
Phone (208) 934-5601
Fax (208) 934-8154
Toxanomy
Taxonomy Code 310500000X
License State Idaho
License Number 38
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According to our database, Gooding Rehab And Living Center NPI is 1023096757, taxonomy code is 310500000X and license number is 38, license state is located at Idaho. Gooding Rehab And Living Center physically located at 1220 Montana St, Gooding ID, 83330-1856. NPI Number 1033115704 has the healthcare provider type.

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1023096757 NPI number is provided on an as is basis without warranty of any kind. 1023096757 is maintained by the National Plan & Provider Enumeration System. The contents of Gooding Rehab And Living Center are for informational purposes only.