Organization
PROHEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAMELA ANN SINCLAIR (CNA OFFICE ASSISTANT)
(208) 235-6565
Entity
Organization
Contact information
Practice address
936 E CENTER ST, POCATELLO, ID 83201-5702
(208) 235-6565
Mailing address
936 E CENTER ST, POCATELLO, ID 83201-5702
(208) 235-6565
(208) 235-7624
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
3140N1450X
Pediatric Skilled Nursing Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0027368
—
ID
05
—
002736800
—
DE
05
—
0027370
—
ID
05
—
002737000
—
ID
Enumeration date
05/31/2007
Last updated
04/17/2008
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