Organization
PEAK MEDICAL OF BOISE, LLC
Active
Other names
Bennett Hills Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
1220 MONTANA STREET, GOODING, ID 83330-1856
(208) 934-5601
(208) 934-8154
Mailing address
1220 MONTANA STREET, GOODING, ID 83330-1856
(208) 934-5601
(208) 934-8154
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8085076
—
ID
Enumeration date
06/07/2010
Last updated
05/16/2016
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