Organization
PEAK MEDICAL OF IDAHO, INC.
Active
Parent organization
SUNBRIDGE HEALTHCARE CORPORATION
Other names
Idaho Falls Care and Rehabilitation Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNBRIDGE HEALTHCARE CORPORATION
Authorized official
WILLIAM A. MATHIES (PRESIDENT DIRECTOR)
(505) 821-3355
Entity
Organization
Contact information
Practice address
3111 CHANNING WAY, IDAHO FALLS, ID 83404-7534
(208) 529-0067
(208) 529-4013
Mailing address
101 SUN AVE NE, COMPLIANCE DEPARTMENT, ALBUQUERQUE, NM 87109-4373
(505) 468-5604
(505) 468-4681
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
53
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010013199
BLUE SHIELD OF IDAHO
ID
01
—
2105
BLUE CROSS
ID
05
—
805152300
—
ID
Enumeration date
05/19/2006
Last updated
09/28/2009
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