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NPI Code Detail

MEDICARE: NINERGK, LLC

MEDICARE: NINERGK, 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
1251G00000XCommunity Based Hospice Care Agency

General Provider Information

NPI Number : 1396891412
Entity Type Code : Organization
Provider Name (Legal Business Name) : NINERGK, LLC
Provider Business Mailing Address
First Line : PO BOX 3881
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83403-3881
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3470 WASHINGTON PKWY
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-7579
Country : US
Telephone Number : 208-542-2999
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : MR. ROBERT COLLETTE
Credential :
Telephone Number : 208-529-0800
Provider Enumeration Date : 01/25/2007
Last Update Date : 08/22/2020

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Directions to “NINERGK, LLC ” Practice Location

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