Basic Information
| Provider Information | |||||||||
| NPI: | 1235683806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAYETTE OF CASCADIA, LLC | ||||||||
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| OtherOrganizationName: | PAYETTE HEALTHCARE OF CASCADIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 408 S EAGLE RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | EAGLE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494166633 | ||||||||
| FaxNumber: | 8443623862 | ||||||||
| Practice Location | |||||||||
| Address1: | 1019 3RD AVENUE SOUTH | ||||||||
| Address2: | |||||||||
| City: | PAYETTE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836612832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086789474 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2016 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | LAFORTE | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL AND DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2063514535 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.