Provider Demographics
NPI:1316757123
Name:POINTE SIDE OPCO LLC
Entity type:Organization
Organization Name:POINTE SIDE OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-706-6918
Mailing Address - Street 1:609 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1120
Mailing Address - Country:US
Mailing Address - Phone:503-706-6918
Mailing Address - Fax:
Practice Address - Street 1:4865 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-6057
Practice Address - Country:US
Practice Address - Phone:541-284-2865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility