NPIMap

Organization Active NPI

Division of Veterans Services

  • Skilled Nursing Facility
  • Lewiston, ID
National Provider Identifier
1679562011
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
91 Issued in ID
Legal business name
DIVISION OF VETERANS SERVICES
Practice address
821 21St Ave
Lewiston, ID 83501-6389
Phone
(208) 799-3422
Fax
(208) 799-3414
NPI assigned
Oct 18, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Authorized official

Name
Tracy Schaner
Title
Deputy Chief Administrator
Phone
(208) 780-1320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 91 ID Primary

Addresses

Primary practice location

821 21St Ave
Lewiston, ID 83501-6389

Mailing address

821 21St Ave
Lewiston, ID 83501-6389
Phone (208) 799-3422

Other identifiers 5

IdentifierTypeStateIssuer
805788200MedicaidID
1042HPOtherIDPHARMACY LICENSE
1307102OtherIDNABP PHARMACY
805741800MedicaidID
91OtherIDNURSING FACILITY LICENSE

Other names 1

  • Idaho State Veterans Home - Lewiston Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071203000058 ID Part A Provider - Skilled Nursing Facility 5698871762 Practice locations: Lewiston, ID

Skilled nursing facility certification: CCN 135133

Legal name
DIVISION OF VETERANS SERVICES
Doing business as
IDAHO STATE VETERANS HOME LEWISTON
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 2007
Last certification
Jun 28, 2024
Beds
66
Ownership / control type
State
Organization structure
OtherNon-profit
Enrollment address
821 21St Ave
Lewiston, ID 83501-6389
Nursing home name
IDAHO STATE VETERANS HOME - LEWISTON

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
Idaho State Veterans Home - LewistonCCN 135133
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
Dec 1, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6648.8 residents per day on average
Penalties (3 years)
1Fines totaling $186,850

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
13D2150943Idaho State Veterans Home-Lewiston821 21St Ave, Lewiston, ID 83501Certificate of waiverJul 8, 2028

National Provider Directory

National Provider Directory
Tax ID family
Division of Veterans Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Mark S High Individual W-2 Managing Employee Jun 29, 2016
Operational/Managerial ControlAdministrator Jun 29, 2016 80%
Division of Veterans Services Organization Other Jan 1, 2006 100%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Idaho State Veterans Home-BoiseBoise, ID, CCN 135131 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jul 1, 2000
Jan 1, 2006
Idaho State Veterans Home - PocatelloPocatello, ID, CCN 135132 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jun 18, 1992
Mar 26, 2007
Idaho State Veterans Home - Post FallsPost Falls, ID, CCN 135148 Skilled nursing facility Operational/Managerial Control (100%) Jul 1, 2018

Owned or controlled facilities with NPI records 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1679562011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 21ST AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835016389",
            "telephone_number": "208-799-3422",
            "fax_number": "208-799-3414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 21ST AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835016389",
            "telephone_number": "208-799-3422",
            "fax_number": "208-799-3414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVISION OF VETERANS SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "SCHANER",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "DEPUTY CHIEF ADMINISTRATOR",
        "authorized_official_telephone_number": "208-780-1320"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "91",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805788200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "1042HP",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP PHARMACY",
            "identifier": "1307102",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805741800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING FACILITY LICENSE",
            "identifier": "91",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho State Veterans Home - Lewiston",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.