Healthcare Provider Details

I. General information

NPI: 1699693283
Provider Name (Legal Business Name): TERRACE HOME HEALTH BOISE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NORTHWEST BLVD STE 120
COEUR D ALENE ID
83814-5047
US

IV. Provider business mailing address

598 W 900 S STE 220
WOODS CROSS UT
84010-8195
US

V. Phone/Fax

Practice location:
  • Phone: 208-765-4343
  • Fax: 208-667-0494
Mailing address:
  • Phone: 801-397-4697
  • Fax: 801-296-9117

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: JASON GATHERUM
Title or Position: CDO
Credential:
Phone: 801-397-4187