Grace Memory Care at State Street LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GRACE MEMORY CARE AT STATE STREET LLC

Practice address

9779 W State St
Boise, ID 83714-1638

Phone

(208) 853-3337

NPI assigned

Jun 2, 2020

Organization subpart

No

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

Authorized official

Name

Linda Hines

Title

Owner

Phone

(208) 853-3337

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1591056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591056000000",
    "number": "1164046413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 N COLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048638",
            "telephone_number": "208-853-3337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9779 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837141638",
            "telephone_number": "208-853-3337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE MEMORY CARE AT STATE STREET LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-02",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A",
        "authorized_official_last_name": "HINES",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-853-3337"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A0003650",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Graber, PHARMD
• Lori Ann Graber, M.O.T O.T.R.
• Grace at Englefield Green LLC
• Grace at State Street LLC
• Grace Counseling, Inc
• Charles Scott Grace, D.D.S
• Janet G Graf, NP
• Michael Edward Graff, MD
• Steven Charles Graff, RPH
• Danielle Ashlin Graffis

• Assisted Living Facility in Boise, ID
• Providers in Boise, ID by specialty
• Assisted Living Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.