NPIMap

Organization Active NPI

Prohealth

  • Adult Care Home Facility
  • Pocatello, ID
National Provider Identifier
1063613495
Registry record updated Apr 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
PROHEALTH
Practice address
936 E Center St
Pocatello, ID 83201-5702
Phone
(208) 235-6565
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2008

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

Authorized official

Name
Mrs. Pamela Ann Sinclair
Title
Cna Office Assistant
Phone
(208) 235-6565

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X Primary
Pediatric Skilled Nursing Facility 3140N1450X

Addresses

Primary practice location

936 E Center St
Pocatello, ID 83201-5702

Mailing address

936 E Center St
Pocatello, ID 83201-5702
Phone (208) 235-6565

Other identifiers 4

IdentifierTypeStateIssuer
0027370MedicaidID
0027368MedicaidID
002737000MedicaidID
002736800MedicaidDE

National Provider Directory

National Provider Directory
Tax ID family
Prohealth2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1063613495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015702",
            "telephone_number": "208-235-6565",
            "fax_number": "208-235-7624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "936 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015702",
            "telephone_number": "208-235-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "SINCLAIR",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CNA OFFICE ASSISTANT",
        "authorized_official_telephone_number": "208-235-6565",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0027370",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0027368",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002737000",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002736800",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; 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.