Healthcare Provider Details

I. General information

NPI: 1053017863
Provider Name (Legal Business Name): NEPENTHE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E 35TH ST
GARDEN CITY ID
83714-6515
US

IV. Provider business mailing address

308 E 35TH ST
GARDEN CITY ID
83714-6515
US

V. Phone/Fax

Practice location:
  • Phone: 208-371-2703
  • Fax:
Mailing address:
  • Phone: 208-371-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY SPEARS
Title or Position: MANAGING MEMBER
Credential: NP
Phone: 208-371-2703