Healthcare Provider Details

I. General information

NPI: 1568980985
Provider Name (Legal Business Name): ACHS HOSPICE & PALLITIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S BRIDGE WAY PL STE 122
EAGLE ID
83616-6022
US

IV. Provider business mailing address

815 S BRIDGE WAY PL STE 122
EAGLE ID
83616-6022
US

V. Phone/Fax

Practice location:
  • Phone: 208-473-2717
  • Fax: 877-890-5617
Mailing address:
  • Phone: 208-473-2717
  • Fax: 877-890-5617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-3215
License Number StateID

VIII. Authorized Official

Name: CHRIS LOUGHEED
Title or Position: PT/DIRECTOR
Credential: PT
Phone: 208-473-2717