Organization
SHOSHONE BANNOCK HOTEL & EVENT CENTER
Active
Parent organization
CEDAR SPA
Other names
Cedar Spa
Organization subpart
Yes
Provider details
NPI number
Legal business name
CEDAR SPA
Authorized official
TAYLIA EDMO LMT (SPA MANAGER)
(208) 238-4850
Entity
Organization
Contact information
Practice address
777 BANNOCK TRAIL, FORT HALL, ID 83203
(208) 238-4850
Mailing address
777 BANNOCK TRAIL, FORT HALL, ID 83203
(208) 238-4850
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020429
HEALTH MANAGEMENT ADMINISTRATORS
ID
Enumeration date
07/01/2022
Last updated
07/01/2022
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