Healthcare Provider Details

I. General information

NPI: 1811985484
Provider Name (Legal Business Name): HELPING HANDS SANCTUARY OF IDAHO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 DE SOTO DRIVE
LOS GATOS CA
95032-2402
US

IV. Provider business mailing address

2043 E. CENTER STREET SUITE 212
POCATELLO ID
83201-3300
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-9151
  • Fax: 408-356-0951
Mailing address:
  • Phone: 208-233-4673
  • Fax: 208-233-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000013
License Number StateCA

VIII. Authorized Official

Name: JOHN B MCNABB
Title or Position: VICE CHAIRMAN, BOARD OF DIRECTORS
Credential:
Phone: 208-251-3681