NPIMap

Organization Active NPI

St. Joseph Hospital, LLC

  • Psychiatric Hospital Unit
  • Lewiston, ID
National Provider Identifier
1205975851
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
ST. JOSEPH HOSPITAL, LLC
Practice address
415 6TH St
Lewiston, ID 83501-2431
Phone
(208) 799-5700
NPI assigned
Feb 6, 2007
Last updated
Jun 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Authorized official

Name
Johnetta Traylor, PESC
Title
Director
Phone
(502) 596-6063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X ID Primary

Addresses

Primary practice location

415 6TH St
Lewiston, ID 83501-2431

Mailing address

680 S 4TH St
License and Certification
Louisville, KY 40202-2407

Other identifiers 6

IdentifierTypeStateIssuer
3500097MedicaidWA
805015100MedicaidID
0008481OtherWAWA L&I MENTAL HEALTH
01347OtherIDBLUE CROSS ID MENTAL HEA
2081804MedicaidWA
72055OtherIDREGENCE OF ID MENTAL HEAL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sjrmc@direct.sjrmc.md

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170602000919 ID Part A Provider - Hospital 8325325806 Practice locations: Lewiston, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205975851. Details of each certification follow.

Hospital certification: CCN 13S003

Legal name
ST JOSEPH HOSPITAL LLC
Doing business as
ST JOSEPH MEDICAL CENTER
Organization structure
LLCProprietary
Incorporated
in DE
Enrollment address
415 6TH St
Lewiston, ID 83501-2431
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Hospital LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

1630 23rd Ave
#701
Lewiston, ID 83501
Phone (208) 743-3998

1630 23rd Ave
#801
Lewiston, ID 83501
Phone (208) 743-6200

2114 Vineyard Ave
Lewiston, ID 83501
Phone (208) 743-4545

307 Saint Johns Way
Ste 1
Lewiston, ID 83501
Phone (208) 743-3998

307 Saint Johns Way
Ste 5
Lewiston, ID 83501
Phone (208) 746-0133

338 6th St
#102
Lewiston, ID 83501
Phone (208) 746-3320

835 SE Bishop Blvd
#140
Pullman, WA 99163
Phone (509) 332-2541

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kindred Healthcare Operating LLC Organization, Louisville, KY Chain home office Operational/Managerial Control Dec 23, 2021 100%
Jacquelyn Joy Davis Individual Contracted Managing EmployeeAd; Mar 17, 2025
Scott Graeser Individual Corporate OfficerVice President, Treasurer Aug 19, 2022
St Joseph Holdings LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Direct Ownership Interest May 1, 2017 100%
Dana M Rock Individual Corporate OfficerAssistant Administrator Dec 9, 2024
Johnetta M Traylor Individual Corporate OfficerAdministrator Dec 9, 2024
W-2 Managing EmployeeAd; Mar 17, 2025
Russell Pigg Individual Corporate DirectorPresident Mar 15, 2025
Knight Health Holdings LLC Organization, Louisville, KY LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 23, 2021 100%
Michael Joseph Bean Individual Corporate OfficerVice President, Tax Jan 21, 2022
Knight Healthcare New-B, LLC Organization, Louisville, KY LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 23, 2021 100%
Knight Health II, LLC Organization, Louisville, KY LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 23, 2021 100%
Alan Wenk Individual Operational/Managerial ControlCfo Mar 17, 2025

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St Joseph Regional Medical CenterLewiston, ID, CCN 13T003 Hospital 5% Or Greater Indirect Ownership Interest Mar 17, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 97

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • St. Joseph Hospital LLC

    dba St. Joseph Regional Medical Center

    • General Acute Care Hospital
    • Lewiston, ID
    • NPI 1225090954

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health II, LLC, Knight Healthcare New-B, LLC, St Joseph Holdings LLC

    CMS ownership
  • St. Joseph Hospital, LLC

    dba St. Joseph Regional Medical Center

    • Rehabilitation Hospital Unit
    • Lewiston, ID
    • NPI 1629783295

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health II, LLC, Knight Healthcare New-B, LLC, St Joseph Holdings LLC

    CMS ownership
  • Andalusia Physician Practices LLC

    dba Andalusia Family Healthcare

    • Rural Health Clinic/Center
    • Andalusia, AL
    • NPI 1417663576

    Knight Health Holdings LLC, Knight Health II, LLC

    CMS ownership
  • CHG Hospital Austin, LLC

    dba Cornerstone Specialty Hospitals Round Rock

    • Rehabilitation Hospital Unit
    • Round Rock, TX
    • NPI 1396326948

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC

    CMS ownership
  • CHG Hospital Austin, LLC

    dba Cornerstone Specialty Hospitals Round Rock

    • Long Term Care Hospital
    • Round Rock, TX
    • NPI 1912395203

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC

    CMS ownership
  • CHG Hospital Conroe, LLC

    dba Cornerstone Specialty Hospitals Conroe

    • Long Term Care Hospital
    • Conroe, TX
    • NPI 1073901476

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC

    CMS ownership
  • CHG Hospital Little Rock, LLC

    dba Cornerstone Specialty Hospitals Little Rock

    • Long Term Care Hospital
    • Little Rock, AR
    • NPI 1346630589

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC

    CMS ownership
  • CHG Hospital McAllen, LLC

    dba Solara Specialty Hospitals McAllen

    • Long Term Care Hospital
    • McAllen, TX
    • NPI 1760870166

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC

    CMS ownership
  • Community Hospital of Andalusia LLC

    dba Andalusia Health

    • General Acute Care Hospital
    • Andalusia, AL
    • NPI 1821078494

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health II, LLC

    CMS ownership
  • Cornerstone Hospital of Huntington, LLC

    dba Cornerstone Specialty Hospitals Huntington

    • Long Term Care Hospital
    • Huntington, WV
    • NPI 1548214786

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC

    CMS ownership
  • Dallas Ltach, LLC

    dba Kindred Hospital Dallas Central

    • Long Term Care Hospital
    • Dallas, TX
    • NPI 1356559991

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC

    CMS ownership
  • Dallas Ltach, LLC

    dba Kindred Hospital Dallas Central (Acute Rehab Unit)

    • Rehabilitation Hospital Unit
    • Dallas, TX
    • NPI 1821741539

    Kindred Healthcare Operating LLC, Knight Health Holdings LLC

    CMS ownership
View all 97

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749513600000",
    "number": "1205975851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 S 4TH ST",
            "address_2": "LICENSE AND CERTIFICATION",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022407",
            "fax_number": "502-212-8481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-799-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A",
        "authorized_official_last_name": "TRAYLOR",
        "authorized_official_first_name": "JOHNETTA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "502-596-6063",
        "authorized_official_credential": "PESC"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3500097",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805015100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L&I MENTAL HEALTH",
            "identifier": "0008481",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS  ID MENTAL HEA",
            "identifier": "01347",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2081804",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE OF ID MENTAL HEAL",
            "identifier": "72055",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sjrmc@direct.sjrmc.md",
            "affiliation": "N",
            "address_1": "415 6th St",
            "city": "Lewiston",
            "state": "ID",
            "country_code": "US",
            "postal_code": "835012431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.