NPIMap

Organization Active NPI

Division of Veterans Services

  • Skilled Nursing Facility
  • Pocatello, ID
National Provider Identifier
1285624064
Registry record updated Feb 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
92 Issued in ID
Legal business name
DIVISION OF VETERANS SERVICES
Practice address
1957 Alvin Ricken Dr
Pocatello, ID 83201-2727
Phone
(208) 236-6340
Fax
(208) 236-6343
NPI assigned
Oct 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2026

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

Authorized official

Name
Tracy Schaner
Title
Deputy Chief Administrator
Phone
(208) 780-1320

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 92 ID Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

1957 Alvin Ricken Dr
Pocatello, ID 83201-2727

Mailing address

1957 Alvin Ricken Dr
Pocatello, ID 83201-2727
Phone (208) 236-6340

Other identifiers 5

IdentifierTypeStateIssuer
805788400MedicaidID
995HPOtherIDPHARMACY LICENSE
92OtherIDNURSING FACILITY LICENSE
1307126OtherIDNCPDP
805755300MedicaidID

Other names 1

  • Idaho State Veterans Home - Pocatello Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080521000658 ID Part A Provider - Skilled Nursing Facility 5698871762 Practice locations: Pocatello, ID

Skilled nursing facility certification: CCN 135132

Legal name
DIVISION OF VETERANS SERVICES
Doing business as
IDAHO STATE VETERANS HOME - POCATELLO
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 2007
Last certification
Jul 19, 2024
Beds
66
Ownership / control type
State
Multi-facility organization
State of Idaho
Organization structure
OtherNon-profit
Enrollment address
1957 Alvin Ricken Dr
Pocatello, ID 83201-2727
Nursing home name
IDAHO STATE VETERANS HOME - POCATELLO

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Idaho State Veterans Home - PocatelloCCN 135132
Overall star rating
5 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Nov 1, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6652.9 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2150884Idaho State Veterans Home-Pocatello1957 Alvin Ricken Dr, Pocatello, ID 83201Certificate of waiverJul 5, 2026

National Provider Directory

National Provider Directory
Tax ID family
Division of Veterans Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Josiah C Dahlstrom Individual Operational/Managerial ControlAdministrator Jul 17, 2014 100%
Division of Veterans Services Organization, Pocatello, ID 5% Or Greater Direct Ownership Interest Jun 18, 1992 100%
Operational/Managerial Control Mar 26, 2007

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Idaho State Veterans Home-BoiseBoise, ID, CCN 135131 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jul 1, 2000
Jan 1, 2006
Idaho State Veterans Home LewistonLewiston, ID, CCN 135133 Skilled nursing facility Other (100%) Jan 1, 2006
Idaho State Veterans Home - Post FallsPost Falls, ID, CCN 135148 Skilled nursing facility Operational/Managerial Control (100%) Jul 1, 2018

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771891200000",
    "number": "1285624064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1957 ALVIN RICKEN DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012727",
            "telephone_number": "208-236-6340",
            "fax_number": "208-236-6343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1957 ALVIN RICKEN DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012727",
            "telephone_number": "208-236-6340",
            "fax_number": "208-236-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVISION OF VETERANS SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2026-02-24",
        "certification_date": "2026-02-24",
        "status": "A",
        "authorized_official_last_name": "SCHANER",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "DEPUTY CHIEF ADMINISTRATOR",
        "authorized_official_telephone_number": "208-780-1320"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "92",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805788400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "995HP",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING FACILITY LICENSE",
            "identifier": "92",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1307126",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805755300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho State Veterans Home - Pocatello",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.