Healthcare Provider Details

I. General information

NPI: 1871055152
Provider Name (Legal Business Name): 3 AND 1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NORTHWEST BLVD STE 110
COEUR D ALENE ID
83814-2788
US

IV. Provider business mailing address

1900 NORTHWEST BLVD STE 110
COEUR D ALENE ID
83814-2788
US

V. Phone/Fax

Practice location:
  • Phone: 208-758-8090
  • Fax: 208-214-3222
Mailing address:
  • Phone: 208-758-8090
  • Fax: 208-214-3222

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: MATT ZASTROW
Title or Position: PART OWNER
Credential:
Phone: 208-758-8090