Healthcare Provider Details

I. General information

NPI: 1699593376
Provider Name (Legal Business Name): HOSPICE OF EASTERN IDAHO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MORAN ST
IDAHO FALLS ID
83401-4337
US

IV. Provider business mailing address

1810 MORAN ST
IDAHO FALLS ID
83401-4337
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-0342
  • Fax: 208-529-6981
Mailing address:
  • Phone: 208-529-0342
  • Fax: 208-529-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CELESTE ELD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 208-529-0342