Healthcare Provider Details

I. General information

NPI: 1902426521
Provider Name (Legal Business Name): ALL GRACE HOME HEALTH, HOSPICE, AND PALLIATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S BRIDGEWAY PL STE 110
EAGLE ID
83616-6021
US

IV. Provider business mailing address

815 S BRIDGEWAY PL STE 110
EAGLE ID
83616-6021
US

V. Phone/Fax

Practice location:
  • Phone: 208-473-2717
  • Fax: 208-473-2451
Mailing address:
  • Phone: 208-473-2717
  • Fax: 208-473-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA HILLESHIEM
Title or Position: PRESIDENT
Credential: RN
Phone: 208-473-2717