Basic Information
| Provider Information | |||||||||
| NPI: | 1285390963 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASCADES AT SUNNY RIDGE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5314 RIVER RUN DR STE 140 | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846047706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014264905 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2609 SUNNYBROOK DR | ||||||||
| Address2: | |||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836866332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003852527 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2021 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCSPADDEN | ||||||||
| AuthorizedOfficialFirstName: | DARIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8014264905 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.