NPIMap

Organization Active NPI

Bear Lake Memorial Hospital

Doing business as Bear Lake Manor

  • Assisted Living Facility
  • Montpelier, ID
National Provider Identifier
1740598614
Registry record updated Sep 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
RC-738 Issued in ID
Legal business name
BEAR LAKE MEMORIAL HOSPITAL
Doing business as
Bear Lake Manor
Practice address
855 Boise St
Montpelier, ID 83254-1070
Phone
(208) 847-2400
NPI assigned
Sep 14, 2010
Last updated
Sep 14, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2010

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

Authorized official

Name
Ryan Messerly
Title
PFS Director
Phone
(208) 847-0920

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X RC-738 ID Primary

Addresses

Primary practice location

855 Boise St
Montpelier, ID 83254-1070

Mailing address

855 Boise St
Montpelier, ID 83254-1070
Phone (208) 847-2400

Other identifiers 1

IdentifierTypeStateIssuer
806513000MedicaidID

Other names 1

  • Bear Lake Manor Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shaun Tobler10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

855 Boise St
Montpelier, ID 83254
Phone (208) 847-2400

NPI Registry JSON

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

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284422400000",
    "number": "1740598614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 BOISE ST",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832541070",
            "telephone_number": "208-847-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 BOISE ST",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832541070",
            "telephone_number": "208-847-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAR LAKE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-14",
        "last_updated": "2010-09-14",
        "status": "A",
        "authorized_official_last_name": "MESSERLY",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PFS DIRECTOR",
        "authorized_official_telephone_number": "208-847-0920"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "ID",
            "license": "RC-738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806513000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bear Lake Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montpelier, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; 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.