Provider Demographics
NPI:1871745372
Name:CHAROLAIS CARE II, INC
Entity type:Organization
Organization Name:CHAROLAIS CARE II, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-221-2019
Mailing Address - Street 1:110 N 800 E
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-5724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:208-904-4030
Practice Address - Street 1:500 POLK ST E
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-1618
Practice Address - Country:US
Practice Address - Phone:208-423-5591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital