Organization
ELEGANT RESIDENTIAL LIVING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODIE KATSILOMETES (ADMINISTRATOR)
(208) 478-9400
Entity
Organization
Contact information
Practice address
1256 WRIGHT AVE BLDG 1234, POCATELLO, ID 83202-5084
(208) 478-9400
Mailing address
1256 WRIGHT AVE BLDG 1234, POCATELLO, ID 83202-5084
(208) 478-9400
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
04/09/2025
Last updated
04/09/2025
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