PROVIDENT FOUNDATION - WEDGEWOOD TERRACE LLC NPI 1295228054

NPI Information

PROVIDENT FOUNDATION - WEDGEWOOD TERRACE LLC is an assisted living facility in Lewiston, ID. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. PROVIDENT FOUNDATION - WEDGEWOOD TERRACE LLC NPI is 1295228054. The provider is registered as an organization entity type.

The provider's business location address is:

2114 VINEYARD AVENUE
LEWISTON, ID
ZIP 83501
Phone: (208) 743-4545
Fax: (208) 743-2268

The provider's authorized official is Debra W. Lockwood .
The authorized official title is President & Chief Financial Officer and has the following contact phone number (225) 766-3977.

The enumeration date for this NPI number is 6/7/2018 and was last updated on 6/7/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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