# POCATELLO HOSPITAL LLC

> 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
- **Parent organization:** PORTNEUF MEDICAL CENTER
- **Other names:** Portneuf Rehabilitation Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144262114
- **Legal business name:** PORTNEUF MEDICAL CENTER
- **Authorized official:** STEPHEN C. PETROVICH (EVP, GENERAL COUNSEL)
- **Authorized official phone:** (615) 296-3594

## Contact information

- **Practice address:** 777 HOSPITAL WAY, POCATELLO, ID 83201-5175
- **Practice address phone:** (208) 239-1000
- **Practice address fax:** (208) 239-1934
- **Mailing address:** 777 HOSPITAL WAY, POCATELLO, ID 83201-5175
- **Mailing address phone:** (208) 239-1000
- **Mailing address fax:** (208) 239-1934

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 273Y00000X | Rehabilitation Hospital Unit | H12 | ID | Yes |

## Other

- **Enumeration date:** 06/12/2006
- **Last updated:** 04/19/2022