Jefferson Residential Services, Inc.
Organization Active NPI Assisted Living Facility · Roberts, ID
NPI 1780901967 · NPPES record last updated Apr 27, 2010
Key facts
- NPI
- 1780901967
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- RC-960 (ID)
- Legal business name
- JEFFERSON RESIDENTIAL SERVICES, INC.
- Practice address
- 2859 E 650 N
Roberts, ID 83444-5095 - Phone
- (208) 228-6045
- NPI assigned
- Apr 27, 2010
- Organization subpart
- No
Authorized official
- Name
- Mr. Todd Graves, QMRP
- Title
- Assistant Director
- Phone
- (208) 228-6045
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | RC-960 | ID | Yes |
Addresses
Primary practice location
2859 E 650 N
Roberts, ID 83444-5095
Mailing address
2859 E 650 N
Roberts, ID 83444-5095
Phone (208) 228-6234
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8082790000 | Medicaid | ID |
Other providers in Roberts, ID
All providers in Roberts, ID · Assisted Living Facility in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.