Healthcare Provider Details

I. General information

NPI: 1447121637
Provider Name (Legal Business Name): HALO HEALTH HOMECARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S ORCHARD ST STE 168
BOISE ID
83705-1977
US

IV. Provider business mailing address

1111 S ORCHARD ST STE 168
BOISE ID
83705-1977
US

V. Phone/Fax

Practice location:
  • Phone: 206-399-6143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FARDOWS MOHAMED
Title or Position: OWNER/ PRESIDENT
Credential:
Phone: 206-399-6143