Healthcare Provider Details

I. General information

NPI: 1043209505
Provider Name (Legal Business Name): PERSONAL CONNECTION HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 11TH AVE N
BUHL ID
83316-1505
US

IV. Provider business mailing address

629 11TH AVE N
BUHL ID
83316-1505
US

V. Phone/Fax

Practice location:
  • Phone: 208-543-8222
  • Fax: 208-543-2725
Mailing address:
  • Phone: 208-543-8222
  • Fax: 208-543-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARILYN MILLS
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-543-8222