Healthcare Provider Details

I. General information

NPI: 1598768483
Provider Name (Legal Business Name): NORTH IDAHO HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 N MERRIT CREEK LOOP
COEUR D ALENE ID
83814-4961
US

IV. Provider business mailing address

2426 N MERRIT CREEK LOOP
COEUR D ALENE ID
83814-4961
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-7494
  • Fax: 208-765-2236
Mailing address:
  • Phone: 208-667-7494
  • Fax: 208-765-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHH159
License Number StateID

VIII. Authorized Official

Name: MR. RICHARD V MCKERNAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-667-7494