Healthcare Provider Details

I. General information

NPI: 1962887000
Provider Name (Legal Business Name): ASPEN PERSONAL CARE SERVICE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E HIGHWAY 200 SUITE 1
CLARK FORK ID
83811
US

IV. Provider business mailing address

PO BOX 279 PO BOX 279
CLARK FORK ID
83811-0279
US

V. Phone/Fax

Practice location:
  • Phone: 208-266-1550
  • Fax: 208-266-1530
Mailing address:
  • Phone: 208-266-1550
  • Fax: 866-308-0781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SAUNDRA LEE SCARLETT
Title or Position: CEO/MEMBER
Credential:
Phone: 208-266-1530