Healthcare Provider Details

I. General information

NPI: 1275456592
Provider Name (Legal Business Name): SUNSET BAY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
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: 208-401-1063
  • Fax:
Mailing address:
  • Phone: 208-401-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

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