Healthcare Provider Details

I. General information

NPI: 1043448400
Provider Name (Legal Business Name): IDAHO HOME HEALTH & HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 IDAHO ST
GOODING ID
83330-1258
US

IV. Provider business mailing address

826 EASTLAND DR
TWIN FALLS ID
83301-6858
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-4842
  • Fax:
Mailing address:
  • Phone: 208-734-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE OSBORN
Title or Position: VP OPERATION/CFO
Credential:
Phone: 208-734-4061