Peterson Place Afh Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

RC1126 Issued in ID

Legal business name

PETERSON PLACE AFH INC

Doing business as

Peterson Place Assisted Living

Practice address

1027 E Honeysuckle Ave
Hayden, ID 83835-9291

Phone

(208) 719-9405

Fax

(208) 719-9406

NPI assigned

Jan 13, 2017

Last updated

Jan 13, 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

Heidi A Peterson

Title

Administrator

Phone

(509) 979-2773

Specialties & licenses 1

Addresses

Other names 1

• Peterson Place Assisted Living Doing business as

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

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1235675380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 E HONEYSUCKLE AVE",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359291",
            "telephone_number": "208-719-9405",
            "fax_number": "208-719-9406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 E HONEYSUCKLE AVE",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359291",
            "telephone_number": "208-719-9405",
            "fax_number": "208-719-9406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON PLACE AFH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-13",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-979-2773"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "ID",
            "license": "RC1126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson Place Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Simone Paras, LMT
• Nicole Marie Parquette, PA-C
• Brigette D Pender, LCSW
• Heather Penske, MS, CCC-SLP
• Periwinkle Children's Therapy
• Chax Brandon Peterson, PHARM. D.
• Tracey Peterson, PHARM D
• Lindsey Nichole Petrick, LCSW
• Physioone
• Savannah Plath, ARNP

• Assisted Living Facility in Hayden, ID
• Providers in Hayden, 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 Jan 13, 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.