Grace Memory Care At State Street LLC
Assisted Living Facility in Boise, ID. Organization (NPI-2).
NPI number1164046413
StatusActive
Last updated in NPPESJun 2, 2020
Details
- NPI
- 1164046413
- Entity type
- Organization (NPI-2)
- Legal business name
- Grace Memory Care At State Street LLC
- Organization subpart
- No
- Enumeration date
- Jun 2, 2020
- Certification date
- Jun 2, 2020
- Last updated
- Jun 2, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 310400000X | Assisted Living Facility | – | – | Yes |
Practice location
9779 W State StBoise, ID 83714-1638
Phone 208-853-3337
Mailing address
890 N Cole RdBoise, ID 83704-8638
Phone 208-853-3337
Authorized official
Linda Hines
Owner
2088533337
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