Lacrosse Health- Coeur D'Alene, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LACROSSE HEALTH- COEUR D'ALENE, LLC

Doing business as

LaCrosse Health & Rehabilitation Center

Practice address

210 W Lacrosse Ave
Coeur D Alene, ID 83814-2403

Phone

(208) 664-2185

Fax

(208) 664-1604

NPI assigned

Nov 24, 2006

Last updated

Aug 17, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dov E. Jacobs

Title

Manager

Phone

(323) 678-4426

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• LaCrosse Health & Rehabilitation Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502928000000",
    "number": "1003982927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 WEST LACROSSE AVENUE",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "838142403",
            "telephone_number": "208-664-2185",
            "fax_number": "208-664-1604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W LACROSSE AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142403",
            "telephone_number": "208-664-2185",
            "fax_number": "208-664-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LACROSSE HEALTH- COEUR D'ALENE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2017-08-17",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "DOV",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "323-678-4426",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000283700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LaCrosse Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Skilled Nursing Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.