Titan Willow Operator LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

TITAN WILLOW OPERATOR LLC

Practice address

898 S Meridian St
Blackfoot, ID 83221-2660

Phone

(208) 782-1478

NPI assigned

Apr 14, 2023

Organization subpart

No

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

Authorized official

Name

Kevin Kaseff

Title

Manager

Phone

(310) 725-0120

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1681430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1326734062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 ROSECRANS AVE STE 4170",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902454966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "898 S MERIDIAN ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212660",
            "telephone_number": "208-782-1478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TITAN WILLOW OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-14",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "KASEFF",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "310-725-0120"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Blackfoot, ID
• Providers in Blackfoot, 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 May 22, 2023; 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.