OAK CREEK REHABILITATION CENTER OF KIMBERLY LLC
Complete NPI Record 1194031286
Skilled Nursing Facility in Kimberly, ID
Active since August 26, 2010CLIA 13D0703636 · Waiver
Complete NPI Dataset
This page contains the complete raw NPPES record for Oak Creek Rehabilitation Center Of Kimberly Llc (NPI 1194031286), a skilled nursing facility organization in Kimberly, ID. All 32 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1194031286 Field 1/32
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/32
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/32
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: OAK CREEK REHABILITATION CENTER OF KIMBERLY LLC Field 4/32
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 275 S 5TH AVE Field 5/32
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Second Line Business Mailing Address: LOWER LEVEL Field 6/32
- The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
- Provider Business Mailing Address City Name: POCATELLO Field 7/32
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: ID Field 8/32
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 832016400 Field 9/32
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 10/32
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 2082334673 Field 11/32
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 2082334750 Field 12/32
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 500 POLK ST E Field 13/32
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: KIMBERLY Field 14/32
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: ID Field 15/32
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 833411618 Field 16/32
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 17/32
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 2084235591 Field 18/32
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 2084235651 Field 19/32
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: EVERTON Field 22/32
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: JAMES Field 23/32
- The first name of the authorized official.
- Authorized Official Middle Name: B Field 24/32
- The middle name of the authorized official.
- Authorized Official Title or Position: CEO Field 25/32
- The title or position of the authorized official.
- Authorized Official Telephone Number: 2082334673 Field 26/32
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 314000000X Field 27/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: 17 Field 28/32
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: ID Field 29/32
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 30/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 31/32
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Authorized Official Name Prefix Text: MR. Field 32/32
- The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.
Other Provider Identifiers 1
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
135084 Medicare OSCAR/certification
Identifier 1/1State: ID
Medicare OSCAR / Certification Number: Identifies an institutional provider of services (such as a hospital, nursing home, or home health agency) assigned by CMS regional offices or state survey-certification agencies.
Medicare OSCAR / Certification Number: Identifies an institutional provider of services (such as a hospital, nursing home, or home health agency) assigned by CMS regional offices or state survey-certification agencies.
No registry entries match your active lookup criteria.
