Basic Information
| Provider Information | |||||||||
| NPI: | 1376728345 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CAREFIX MANAGEMENT AND CONSULTING, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAFEHAVEN CARE CENTER OF GOODING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 STOCKMAN RD | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832042070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082214721 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1220 MONTANA ST | ||||||||
| Address2: | |||||||||
| City: | GOODING | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833301856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089345601 | ||||||||
| FaxNumber: | 2087315338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2008 | ||||||||
| LastUpdateDate: | 01/08/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHANDLER | ||||||||
| AuthorizedOfficialFirstName: | LEWIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2082512699 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 38 | ID | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.