Organization
TWIN FALLS CHARDONNAY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BASCOM (PRINCIPAL)
(360) 722-4062
Entity
Organization
Contact information
Practice address
1045 CARRIAGE LN, TWIN FALLS, ID 83301-6751
(208) 736-4608
Mailing address
4340 STONEBROOK LN, IDAHO FALLS, ID 83404-8022
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
07/19/2025
Last updated
07/29/2025
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