Organization
GRACE AT STATE STREET LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA HINES (OWNER)
(208) 342-1312
Entity
Organization
Contact information
Practice address
9995 W STATE ST, BOISE, ID 83714-1636
(208) 853-3337
Mailing address
890 N COLE RD, BOISE, ID 83704-8638
(208) 853-3337
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0002183
—
ID
Enumeration date
06/02/2020
Last updated
06/02/2020
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