Healthcare Provider Details

I. General information

NPI: 1760730196
Provider Name (Legal Business Name): COORDINATED SERVICES OF IDAHO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E SHERMAN AVE
COEUR D ALENE ID
83814-4154
US

IV. Provider business mailing address

301 S WIDE RIVER RD
POST FALLS ID
83854-7011
US

V. Phone/Fax

Practice location:
  • Phone: 208-660-9534
  • Fax: 208-665-5795
Mailing address:
  • Phone: 208-660-9534
  • Fax: 208-665-5795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALESSANDRA BERTOZZI BILLINGSLEA
Title or Position: QWNER
Credential: M.ED.
Phone: 208-660-9534