Basic Information
| Provider Information | |||||||||
| NPI: | 1306094610 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHAROLAIS CARE III, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DESERT VIEW CARE CENTER OF BUHL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 N 800 E | ||||||||
| Address2: | |||||||||
| City: | JEROME | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833385724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 2089044030 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 SPRAGUE AVE | ||||||||
| Address2: | |||||||||
| City: | BUHL | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833161827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085436401 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2008 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PASQUALE | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | DAWN | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2084235591 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.