Healthcare Provider Details

I. General information

NPI: 1881358737
Provider Name (Legal Business Name): LINK HOME THERAPY SERVICES OF IDAHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W BANNOCK ST STE 1100
BOISE ID
83702-6140
US

IV. Provider business mailing address

180 SYLVAN AVE STE 401
ENGLEWOOD CLIFFS NJ
07632-2512
US

V. Phone/Fax

Practice location:
  • Phone: 917-855-2114
  • Fax:
Mailing address:
  • Phone: 917-855-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AVRAHAM FRIEDMAN
Title or Position: COO
Credential:
Phone: 917-855-2114