Healthcare Provider Details

I. General information

NPI: 1447999883
Provider Name (Legal Business Name): ABC HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W 15TH ST
IDAHO FALLS ID
83402-4269
US

IV. Provider business mailing address

570 W 15TH ST
IDAHO FALLS ID
83402-4269
US

V. Phone/Fax

Practice location:
  • Phone: 208-525-6104
  • Fax: 208-525-6106
Mailing address:
  • Phone: 208-525-6104
  • Fax: 208-525-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PARALEA FURNISS
Title or Position: PRESIDENT
Credential:
Phone: 208-200-6100