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Mr. Jack Lane IV, PTA
Skilled Nursing Facility in Lewiston, Idaho
NPI 1275902520

Jack Lane IV is a Skilled Nursing Facility based in Lewiston, ID. Jack Lane IV practices in Lewiston, ID and has the professional credentials of PTA. The NPI Number for Jack Lane IV is 1275902520 and holds a License No. PTA-3672 (Idaho).

The current practice location address for Jack Lane IV is 615 29Th St, Lewiston, ID and can be reached out via phone at 208-985-4722. You can also correspond with Jack Lane IV through the mailing address at 615 29TH ST, LEWISTON, ID - 83501-3341 (mailing address contact number: 208-985-4722).

Location: 615 29Th St, Lewiston, ID, 83501-3341
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1275902520
Provider Name
Jack Lane IV
Credential
PTA
Provider Entity Type
Individual
Gender
Male
Address
615 29Th St, Lewiston, ID, 83501-3341
Phone Number
208-985-4722
Fax Number
Provider Enumeration Date
09/16/2015
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
615 29Th St
City
Lewiston
State
Idaho
Zip
83501-3341
Phone Number
208-985-4722
Fax Number
person
Provider Business Mailing Address Details
Address
615 29Th St
City
Lewiston
State
Idaho
Zip
83501-3341
Phone Number
208-985-4722
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Skilled Nursing Facility
Speciality
-
Taxonomy
314000000X
License No.
PTA-3672 (Idaho)
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
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