Provider Demographics
NPI:1811607757
Name:HERITAGE OF SODA SPRINGS LLC
Entity type:Organization
Organization Name:HERITAGE OF SODA SPRINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SNEDAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-889-7105
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-0047
Mailing Address - Country:US
Mailing Address - Phone:801-889-7105
Mailing Address - Fax:208-682-7771
Practice Address - Street 1:425 S SPRING CREEK DR
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276-1628
Practice Address - Country:US
Practice Address - Phone:208-547-0257
Practice Address - Fax:208-682-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility