Healthcare Provider Details

I. General information

NPI: 1922007004
Provider Name (Legal Business Name): GEM HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 E LOCUST ST
EMMETT ID
83617-2776
US

IV. Provider business mailing address

1202 E LOCUST ST
EMMETT ID
83617-2715
US

V. Phone/Fax

Practice location:
  • Phone: 208-365-3561
  • Fax: 208-365-4176
Mailing address:
  • Phone: 208-365-3561
  • Fax: 208-365-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHH130
License Number StateID

VIII. Authorized Official

Name: MR. MAX LONG
Title or Position: CEO / ADMINISTRATOR
Credential:
Phone: 208-365-3561