Moscow of Olympus LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MOSCOW OF OLYMPUS LLC

Practice address

640 N Eisenhower St
Moscow, ID 83843-9588

Phone

(208) 401-9600

Fax

(208) 314-0639

NPI assigned

Oct 25, 2022

Last updated

Feb 23, 2023By 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

Heather Baird

Title

Assistant General Counsel

Phone

(208) 401-9600

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1689391161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 E RIVERSIDE DR STE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167621",
            "telephone_number": "208-401-9600",
            "fax_number": "208-314-0639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 N EISENHOWER ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838439588",
            "telephone_number": "208-401-9600",
            "fax_number": "208-314-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSCOW OF OLYMPUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-25",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "BAIRD",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "ASSISTANT GENERAL COUNSEL",
        "authorized_official_telephone_number": "208-401-9600"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Arista A Munsel, DCP
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• Assisted Living Facility in Moscow, ID
• Providers in Moscow, 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 Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.