Provider Demographics
NPI:1063592293
Name:NORTHWEST BEC CORP
Entity type:Organization
Organization Name:NORTHWEST BEC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AR SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ADAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-221-6828
Mailing Address - Street 1:PO BOX 4837
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4837
Mailing Address - Country:US
Mailing Address - Phone:208-637-0999
Mailing Address - Fax:208-637-1195
Practice Address - Street 1:820 SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-1827
Practice Address - Country:US
Practice Address - Phone:208-543-6401
Practice Address - Fax:208-543-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID27314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID135089Medicare ID - Type Unspecified