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1958

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Company Details

Name: 1958
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 30 Aug 2011 (14 years ago)
Entity Number: 455829
Place of Formation: IDAHO
File Number: 0000455829
ZIP code: 83301
County: Twin Falls County
Mailing Address: 2124 STADIUM BLVD TWIN FALLS, ID 83301

National Provider Identifier

NPI Number:
1013306307

Authorized Person:

Name:
LORAINE POWELL
Role:
REGISTERED NURSE
Phone:

Taxonomy:

Selected Taxonomy:
282NR1301X - Rural Acute Care Hospital
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0000455829 2011-08-30

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State