Healthcare Provider Details

I. General information

NPI: 1114637006
Provider Name (Legal Business Name): COMMUNITY NURSING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MORAN ST
IDAHO FALLS ID
83401-4337
US

IV. Provider business mailing address

2830 S REDWOOD RD STE A
WEST VALLEY CITY UT
84119-5626
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-0342
  • Fax:
Mailing address:
  • Phone: 801-639-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LANECE BRINKERHOFF
Title or Position: VP CONTRACTING
Credential:
Phone: 801-233-6100