Organization
MINI-CASSIA CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES B EVERTON (CEO)
(208) 233-4673
Entity
Organization
Contact information
Practice address
1729 MILLER AVE, BURLEY, ID 83318-2338
(208) 678-9474
(208) 678-3727
Mailing address
275 S 5TH AVE, LOWER LEVEL, POCATELLO, ID 83201-6400
(208) 233-4673
(208) 233-4750
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
42
ID
Other
Enumeration date
09/08/2010
Last updated
09/08/2010
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