Healthcare Provider Details

I. General information

NPI: 1417260563
Provider Name (Legal Business Name): IF HOSPICE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 ENERGY PL STE 2
IDAHO FALLS ID
83401-1033
US

IV. Provider business mailing address

PO BOX 1784
IDAHO FALLS ID
83403-1784
US

V. Phone/Fax

Practice location:
  • Phone: 208-757-8444
  • Fax: 877-709-6444
Mailing address:
  • Phone: 208-757-8444
  • Fax: 877-709-6444

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: MR. JUSTIN GREGORY
Title or Position: CFO
Credential:
Phone: 208-346-7807