Organization
DIVISION OF VETERANS SERVICES
Active
Other names
Idaho State Veterans Home - Pocatello
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY SCHANER (DEPUTY CHIEF ADMINISTRATOR)
(208) 780-1320
Entity
Organization
Contact information
Practice address
1957 ALVIN RICKEN DR, POCATELLO, ID 83201-2727
(208) 236-6340
(208) 236-6343
Mailing address
1957 ALVIN RICKEN DR, POCATELLO, ID 83201-2727
(208) 236-6340
(208) 236-6343
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
92
ID
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1307126
NCPDP
ID
05
—
805755300
—
ID
05
—
805788400
—
ID
01
—
92
NURSING FACILITY LICENSE
ID
01
—
995HP
PHARMACY LICENSE
ID
Enumeration date
10/24/2005
Last updated
02/24/2026
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