Healthcare Provider Details

I. General information

NPI: 1881697118
Provider Name (Legal Business Name): PRESCRIPTION CENTER HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 CORONADO ST
IDAHO FALLS ID
83404-7552
US

IV. Provider business mailing address

2250 CORONADO ST
IDAHO FALLS ID
83404-7552
US

V. Phone/Fax

Practice location:
  • Phone: 208-528-7979
  • Fax: 208-523-2238
Mailing address:
  • Phone: 208-528-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. NED HILLYARD
Title or Position: OWNER/MANAGER
Credential:
Phone: 208-709-4571