Healthcare Provider Details

I. General information

NPI: 1992649289
Provider Name (Legal Business Name): 633 CAPITAL HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 E SHERMAN AVE STE 104
COEUR D ALENE ID
83814-5364
US

IV. Provider business mailing address

2115 E SHERMAN AVE STE 104
COEUR D ALENE ID
83814-5364
US

V. Phone/Fax

Practice location:
  • Phone: 208-985-8079
  • 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

VIII. Authorized Official

Name: DEVEN MARSHALL
Title or Position: OWNER
Credential:
Phone: 208-985-8079