Active NPI
Eva Crucillo Bolivar-Guth
- Adult Care Home Facility
- Meridian, ID
National Provider Identifier
1790693604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Care Home Facility
- Practice address
- 323 S Pennant PL
Meridian, ID 83642-2868 - Phone
- (562) 256-5302
- NPI assigned
- Aug 31, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | ID | Primary |
Addresses
Primary practice location
323 S Pennant PL
Meridian, ID 83642-2868
Mailing address
324 S Pennant PL
Meridian, ID 83642
Phone (562) 256-5302
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788134400000",
"number": "1790693604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 S PENNANT PL",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "83642",
"telephone_number": "562-256-5302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "323 S PENNANT PL",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836422868",
"telephone_number": "562-256-5302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLIVAR-GUTH",
"first_name": "EVA",
"middle_name": "CRUCILLO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-08-31",
"last_updated": "2026-08-31",
"certification_date": "2026-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "ID",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.