Organization
ST. JOSEPH HOSPITAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR PESC (DIRECTOR)
(502) 596-6063
Entity
Organization
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 799-5700
Mailing address
680 S 4TH ST, LICENSE AND CERTIFICATION, LOUISVILLE, KY 40202-2407
(502) 212-8481
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008481
WA L&I MENTAL HEALTH
WA
01
—
01347
BLUE CROSS ID MENTAL HEA
ID
05
—
2081804
—
WA
05
—
3500097
—
WA
01
—
72055
REGENCE OF ID MENTAL HEAL
ID
05
—
805015100
—
ID
Enumeration date
02/06/2007
Last updated
06/10/2025
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