Titan Streamside Operator, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

TITAN STREAMSIDE OPERATOR, LLC

Practice address

1355 S Edgewater Cir
Nampa, ID 83686-6085

Phone

(208) 442-0097

NPI assigned

Jul 22, 2024

Organization subpart

No

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

Authorized official

Name

Rebecca Wong

Title

Cfo

Phone

(310) 725-0120

Specialties & licenses 2

Addresses

Other names 1

• Streamside Assisted Living and Memory Care Doing business as

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

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1295563385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 APOLLO ST STE 100",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902454641",
            "telephone_number": "310-725-0120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 S EDGEWATER CIR",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866085",
            "telephone_number": "208-442-0097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TITAN STREAMSIDE OPERATOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "310-725-0120"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Streamside Assisted Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeremy Thorson, B.S
• Megan Threatte
• Three Hearts Therapy LLC
• Savannah Lynn Thurman, BS
• Daniel L Tiller, O.D.
• Mary Elisabeth Titmus, PA-C
• Diane E. Tobin, MNT
• Todd L Squires DDC PLLC
• Amanda Todd, BA
• Dennis Tofteland

• Assisted Living Facility in Nampa, ID
• Providers in Nampa, 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 Jul 22, 2024; 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.