Healthcare Provider Details

I. General information

NPI: 1366686826
Provider Name (Legal Business Name): ADVANCED HOME HEALTH AND HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 ENERGY PL STE 1
IDAHO FALLS ID
83401-1502
US

IV. Provider business mailing address

850 ENERGY PL STE 1
IDAHO FALLS ID
83401-1502
US

V. Phone/Fax

Practice location:
  • Phone: 208-346-7807
  • Fax: 208-346-7790
Mailing address:
  • Phone: 208-346-7807
  • Fax: 208-346-7790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberN-30834
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberN-30834
License Number StateID

VIII. Authorized Official

Name: CHERYL ABEL
Title or Position: COO
Credential:
Phone: 208-346-7807