Healthcare Provider Details

I. General information

NPI: 1962328021
Provider Name (Legal Business Name): CORTLAND HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5526 THUNDER DR
AMMON ID
83406-5036
US

IV. Provider business mailing address

784 S CLEARWATER LOOP STE R
POST FALLS ID
83854-9599
US

V. Phone/Fax

Practice location:
  • Phone: 986-275-7730
  • Fax:
Mailing address:
  • Phone: 986-275-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: JESSE GURR
Title or Position: OWNER
Credential:
Phone: 986-275-7730