Healthcare Provider Details

I. General information

NPI: 1740801505
Provider Name (Legal Business Name): AAA AMERICAN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E 17TH ST
IDAHO FALLS ID
83404-6273
US

IV. Provider business mailing address

665 JOHN ADAMS PKWY
IDAHO FALLS ID
83401-4072
US

V. Phone/Fax

Practice location:
  • Phone: 208-538-1999
  • Fax:
Mailing address:
  • Phone: 208-419-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: CRISTY STIBAL
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 208-538-3122