Etros Living, LLC

Key facts

NPI

1568972016

Entity type

Organization (NPI type 2)

Primary specialty

Assisted Living Facility 310400000X

Legal business name

ETROS LIVING, LLC

Practice address

840 E Dalton Ave
Coeur D Alene, ID 83815-9338

Phone

(208) 665-2100

Fax

(208) 665-9250

NPI assigned

Oct 10, 2017

Organization subpart

No

Authorized official

Name

Mrs. Amber Williams

Title

Ceo

Phone

(845) 248-4554

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

Other names

• Opus Living, LLC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 17, 2018.

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1568972016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2986 N GRAND FIR DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838156253",
            "telephone_number": "845-248-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 E DALTON AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838159338",
            "telephone_number": "208-665-2100",
            "fax_number": "208-665-9250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 E Sherman Ave",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838145335",
            "country_code": "US",
            "telephone_number": "208-765-8364",
            "fax_number": "208-765-3396",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "208 S Division St",
            "address_purpose": "LOCATION",
            "city": "Pinehurst",
            "state": "ID",
            "postal_code": "838508700",
            "country_code": "US",
            "telephone_number": "208-682-9170",
            "fax_number": "208-682-2509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ETROS LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-10",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "845-248-4554",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO DEPARTMENT OF HEALTH AND WELFARE RESIDENTIAL CARE FACILITY LICENSE",
            "identifier": "RC-1065",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO DEPARTMENT OF HEALTH AND WELFARE RESIDENTIAL CARE FACILITY LICENSE",
            "identifier": "RC-1066",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO DEPARTMENT OF HEALTH AND WELFARE RESIDENTIAL CARE FACILITY LICENSE",
            "identifier": "RC-1067",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Opus Living, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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