Provider Demographics
NPI:1538567532
Name:CHAROLAIS CARE VIII, INC
Entity type:Organization
Organization Name:CHAROLAIS CARE VIII, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PASQUALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-736-1050
Mailing Address - Street 1:650 ADDISON AVE W
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5851
Mailing Address - Country:US
Mailing Address - Phone:208-736-1050
Mailing Address - Fax:208-733-2367
Practice Address - Street 1:650 ADDISON AVE W
Practice Address - Street 2:SUITE 400
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5851
Practice Address - Country:US
Practice Address - Phone:208-736-1050
Practice Address - Fax:208-733-2367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRP HEALTH MANAGEMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID385173245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID38517OtherSTATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE