Provider Demographics
NPI:1053357038
Name:AHC OF BOISE LLC
Entity type:Organization
Organization Name:AHC OF BOISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OXNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9860
Mailing Address - Street 1:2867 E COPPER POINT DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1716
Mailing Address - Country:US
Mailing Address - Phone:208-401-9100
Mailing Address - Fax:208-401-9150
Practice Address - Street 1:2867 E COPPER POINT DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1716
Practice Address - Country:US
Practice Address - Phone:208-401-9100
Practice Address - Fax:208-401-9150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW AHC HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID135130Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER