GRACE AT STATE STREET LLC NPI 1356965693

NPI Information

  • NPI: 1356965693
  • Provider Name: GRACE AT STATE STREET LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • CLIA Number: 13D2194053
  • Address: 9995 W STATE ST
    BOISE, ID
    ZIP 83714
  • Phone: (208) 853-3337

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NPI Details

GRACE AT STATE STREET LLC is an assisted living facility in Boise, 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. GRACE AT STATE STREET LLC NPI is 1356965693. The provider is registered as an organization entity type.

The provider's business location address is:

9995 W STATE ST
BOISE, ID
ZIP 83714-636
Phone: (208) 853-3337

The provider's authorized official is Linda Hines .
The authorized official title is Owner and has the following contact phone number (208) 342-1312.

The CLIA number assigned to this NPI record is 13D2194053 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/2/2020 and was last updated on 6/2/2020.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1A0002183MEDICAIDIDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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