MEDICARE: HOME HEALTH SERVICES OF IDAHO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1285930172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME HEALTH SERVICES OF IDAHO LLC

Provider Business Mailing Address
First Line	:	1065 E WINDING CREEK DR
Second Line	:	SUITE 200
City	:	EAGLE
State	:	ID
Zip	:	83616-7243
Country	:	US
Telephone Number	:	208-938-9681
Fax Number	:	208-515-7957

Provider Business Practice Location Address
First Line	:	1065 E WINDING CREEK DR
Second Line	:	SUITE 200
City	:	EAGLE
State	:	ID
Zip	:	83616-7243
Country	:	US
Telephone Number	:	208-938-9681
Fax Number	:	208-515-7957

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC E. MOTT
Credential	:
Telephone Number	:	208-938-9681

Provider Enumeration Date	:	02/10/2011
Last Update Date	:	02/10/2011

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