Organization
1958
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORAINE POWELL (REGISTERED NURSE)
(619) 838-4593
Entity
Organization
Contact information
Practice address
730 E CLARK ST, #4657, POCATELLO, ID 83205-5401
(619) 838-4593
Mailing address
9344 NATIONAL BLVD APT 11, LOS ANGELES, CA 90034-2925
(619) 838-4593
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
728144
CA
Other
Enumeration date
01/09/2015
Last updated
01/09/2015
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