Basic Information
| Provider Information | |||||||||
| NPI: | 1871200154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASCADES AT LINCOLN COUNTY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5314 N RIVER RUN DRIVE STE 140 | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014264905 | ||||||||
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| Practice Location | |||||||||
| Address1: | 511 E 4TH ST | ||||||||
| Address2: | |||||||||
| City: | SHOSHONE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833525380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088862228 | ||||||||
| FaxNumber: | 2089699107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2022 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCSPADDEN | ||||||||
| AuthorizedOfficialFirstName: | DARIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8014264905 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.