NPIMap

Organization Active NPI

State of Idaho Department of Health and Welfare

  • Skilled Nursing Facility
  • Blackfoot, ID
National Provider Identifier
1518022342
Registry record updated Feb 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
H17 Issued in ID
Legal business name
STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
Practice address
700 E Alice St
Box 400
Blackfoot, ID 83221-4925
Phone
(208) 785-1200
Fax
(208) 785-8518
NPI assigned
Dec 22, 2006
Last updated
Feb 8, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2012

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

Authorized official

Name
Mrs. Tracey G. Sessions
Title
Administrative Director
Phone
(208) 785-8402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X H17 ID Primary

Addresses

Primary practice location

700 E Alice St
Box 400
Blackfoot, ID 83221-4925

Mailing address

700 East Alice Street
PO Box 400
Blackfoot, ID 83221
Phone (208) 785-1200

Other identifiers 1

IdentifierTypeStateIssuer
002826200MedicaidID

Other names 1

  • Syringa Chalet Nursing Facility Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110217000693 ID Part A Provider - Skilled Nursing Facility 6002878527

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518022342. Details of each certification follow.

Skilled nursing facility certification: CCN 135111

Legal name
STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
Doing business as
SYRINGA CHALET NURSING FACILITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 12, 1990
Last certification
Dec 6, 2024
Beds
42
Ownership / control type
State
Organization structure
OtherNon-profit
Enrollment address
700 E Alice St
Blackfoot, ID 83221-4925
Nursing home name
SYRINGA CHALET NURSING FACILITY

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
Syringa Chalet Nursing FacilityCCN 135111 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Mar 12, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4234.6 residents per day on average
Penalties (3 years)
1Fines totaling $13,923

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
13D2189397Syringa Chalet Nursing Facility700 E Alice St, Blackfoot, ID 83221Certificate of waiverJul 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
State of Idaho Dept Health114 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

700 E Alice St
#400
Blackfoot, ID 83221
Phone (208) 785-1200

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
David Brog Individual Operational/Managerial Control Aug 1, 2022
Adp of the SNF Aug 1, 2022
Abbe Fisher Individual Operational/Managerial Control Jul 5, 2016
Angela Loosli Individual Operational/Managerial Control Aug 14, 2017
Adp of the SNF Aug 14, 2017
State of Idaho Department of Health and Welfare Organization, Blackfoot, ID Operational/Managerial Control May 23, 2008 100%
Mark E Lupton Individual Operational/Managerial Control Jul 15, 2019
Adp of the SNF Aug 20, 2025

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
State Hospital SouthBlackfoot, ID, CCN 134010 Hospital Other Jan 1, 1966
State Hospital WestNampa, ID, CCN 134018 Hospital Other (100%) Jan 1, 2021

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328659200000",
    "number": "1518022342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 EAST ALICE STREET",
            "address_2": "PO BOX 400",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "83221",
            "telephone_number": "208-785-1200",
            "fax_number": "208-785-8518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E ALICE ST",
            "address_2": "BOX 400",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832214925",
            "telephone_number": "208-785-1200",
            "fax_number": "208-785-8518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2012-02-08",
        "status": "A",
        "authorized_official_last_name": "SESSIONS",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "208-785-8402",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "H17",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002826200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Syringa Chalet Nursing Facility",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Blackfoot, ID

Sources for this page

Verify at the official NPI Registry.