Provider Demographics
NPI:1194687236
Name:CALDWELL SENIOR LIVING LLC
Entity type:Organization
Organization Name:CALDWELL SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR LEGAL/RISK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-342-5175
Mailing Address - Street 1:4119 LENITY LIVING AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4119 LENITY LIVING AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4988
Practice Address - Country:US
Practice Address - Phone:208-454-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility