NPIMap

Organization Active NPI

Blaine Manor

  • Skilled Nursing Facility
  • Hailey, ID
National Provider Identifier
1760438964
Registry record updated Dec 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
H6 Issued in ID
Legal business name
BLAINE MANOR
Practice address
706 S Main St
Hailey, ID 83333
Phone
(208) 578-3504
Fax
(208) 788-7210
NPI assigned
May 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2007

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

Authorized official

Name
Gail Goglia, RN
Title
Administrator
Phone
(208) 578-3502

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X H6 ID Primary

Addresses

Primary practice location

706 S Main St
Hailey, ID 83333

Mailing address

PO Box 927
Hailey, ID 83333-0927
Phone (208) 578-3504

National Provider Directory

National Provider Directory
Tax ID family
Beacon Health Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1760438964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 927",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833330927",
            "telephone_number": "208-578-3504",
            "fax_number": "208-788-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 S MAIN ST",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "83333",
            "telephone_number": "208-578-3504",
            "fax_number": "208-788-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAINE MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "GOGLIA",
        "authorized_official_first_name": "GAIL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-578-3502",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "H6",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hailey, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; 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.