# 1958

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013306307
- **Authorized official:** LORAINE POWELL (REGISTERED NURSE)
- **Authorized official phone:** (619) 838-4593

## Contact information

- **Practice address:** 730 E CLARK ST, \#4657, POCATELLO, ID 83205-5401
- **Practice address phone:** (619) 838-4593
- **Mailing address:** 9344 NATIONAL BLVD APT 11, LOS ANGELES, CA 90034-2925
- **Mailing address phone:** (619) 838-4593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282NR1301X | Rural Acute Care Hospital | 728144 | CA | Yes |

## Other

- **Enumeration date:** 01/09/2015
- **Last updated:** 01/09/2015