Organization
ST. JOSEPH HOSPITAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (AO)
(502) 596-6063
Entity
Organization
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 799-5200
(208) 799-5554
Mailing address
680 S 4TH ST # KH-3, LOUISVILLE, KY 40202-2407
(502) 596-6063
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805059500
—
ID
01
—
820204264-011
CHAMPUS HOSPICE
ID
01
—
H0176
BLUE CROSS IDAHO HOSPICE
ID
Enumeration date
02/06/2007
Last updated
06/23/2025
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