Healthcare Provider Details

I. General information

NPI: 1528225679
Provider Name (Legal Business Name): DCC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W KATHLEEN AVE
COEUR D ALENE ID
83815-9406
US

IV. Provider business mailing address

109 W KATHLEEN AVE
COEUR D ALENE ID
83815-9406
US

V. Phone/Fax

Practice location:
  • Phone: 208-769-9560
  • Fax: 208-769-9522
Mailing address:
  • Phone: 208-769-9560
  • Fax: 208-769-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CONNIE P CLARK
Title or Position: MANAGING MEMBER
Credential:
Phone: 208-769-9560