Etosha Assisted Living, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

ETOSHA ASSISTED LIVING, INC

Practice address

243 N 300 E
Rupert, ID 83350-9491

Phone

(208) 436-3332

Fax

(208) 436-1289

NPI assigned

Sep 20, 2020

Last updated

Sep 20, 2020By 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

Mrs. Deborah O Covey

Title

Owner, Director of Operations

Phone

(530) 510-0283

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1600560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600560000000",
    "number": "1407462906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 N 300 E",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833509491",
            "telephone_number": "530-510-0283",
            "fax_number": "208-436-1289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 N 300 E",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833509491",
            "telephone_number": "208-436-3332",
            "fax_number": "208-436-1289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETOSHA ASSISTED LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-20",
        "last_updated": "2020-09-20",
        "certification_date": "2020-09-20",
        "status": "A",
        "authorized_official_last_name": "COVEY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER, DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "530-510-0283",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Rupert, ID
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2020; 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.