Oak Creek Rehabilitation Center of Kimberly LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

17 Issued in ID

Legal business name

OAK CREEK REHABILITATION CENTER OF KIMBERLY LLC

Practice address

500 Polk St E
Kimberly, ID 83341-1618

Phone

(208) 423-5591

Fax

(208) 423-5651

NPI assigned

Aug 26, 2010

Last updated

Aug 26, 2010By 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. James B Everton

Title

Ceo

Phone

(208) 233-4673

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1282780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282780800000",
    "number": "1194031286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 S 5TH AVE",
            "address_2": "LOWER LEVEL",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016400",
            "telephone_number": "208-233-4673",
            "fax_number": "208-233-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 POLK ST E",
            "city": "KIMBERLY",
            "state": "ID",
            "postal_code": "833411618",
            "telephone_number": "208-423-5591",
            "fax_number": "208-423-5651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK CREEK REHABILITATION CENTER OF KIMBERLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-26",
        "last_updated": "2010-08-26",
        "status": "A",
        "authorized_official_last_name": "EVERTON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-233-4673",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "17",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; 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.