Organization
DIVISION OF VETERANS SERVICES
Active
Other names
Idaho State Veterans Home - Lewiston
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY SCHANER (DEPUTY CHIEF ADMINISTRATOR)
(208) 780-1320
Entity
Organization
Contact information
Practice address
821 21ST AVE, LEWISTON, ID 83501-6389
(208) 799-3422
(208) 799-3414
Mailing address
821 21ST AVE, LEWISTON, ID 83501-6389
(208) 799-3422
(208) 799-3414
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
91
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1042HP
PHARMACY LICENSE
ID
01
—
1307102
NABP PHARMACY
ID
05
—
805741800
—
ID
05
—
805788200
—
ID
01
—
91
NURSING FACILITY LICENSE
ID
Enumeration date
10/18/2005
Last updated
10/30/2024
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