Coeur D Alene Homes Phase II

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

COEUR D ALENE HOMES PHASE II

Practice address

624 W Harrison Ave
Coeur D Alene, ID 83814-5286

Phone

(208) 664-8119

Fax

(208) 292-2551

NPI assigned

Aug 26, 2020

Organization subpart

No

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

Authorized official

Name

Tiffany Pettit

Title

Administrator

Phone

(208) 664-8119

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Orchard Ridge Assisted Living Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745452800000",
    "number": "1306459599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 W HARRISON AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145286",
            "telephone_number": "208-664-8119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 W HARRISON AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145286",
            "telephone_number": "208-664-8119",
            "fax_number": "208-292-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COEUR D ALENE HOMES PHASE II",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-26",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-664-8119"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M8075669",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://www.theorchardcda.org/",
            "affiliation": "N",
            "endpointDescription": "Orchard Ridge Senior Living",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "624 W Harrison Ave",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838145286",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Orchard Ridge Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Coeur D Alene, ID
• Providers in Coeur D Alene, 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 Apr 24, 2025; 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.