Organization
BLAINE MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAIL GOGLIA RN (ADMINISTRATOR)
(208) 578-3502
Entity
Organization
Contact information
Practice address
706 S MAIN ST, HAILEY, ID 83333
(208) 578-3504
(208) 788-7210
Mailing address
PO BOX 927, HAILEY, ID 83333-0927
(208) 578-3504
(208) 788-7210
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
H6
ID
Other
Enumeration date
05/26/2006
Last updated
12/18/2007
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