Healthcare Provider Details

I. General information

NPI: 1558265157
Provider Name (Legal Business Name): HARTFORD HEALTHCARE HOMECARE AND HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 E RIVERSIDE DR STE 150
EAGLE ID
83616-7584
US

IV. Provider business mailing address

1675 E RIVERSIDE DR STE 150
EAGLE ID
83616-7584
US

V. Phone/Fax

Practice location:
  • Phone: 208-207-2728
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMBER TUELLER
Title or Position: SECRETARY
Credential:
Phone: 208-207-2726