Healthcare Provider Details

I. General information

NPI: 1649199571
Provider Name (Legal Business Name): SHADOW PEAK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 W FLUORITE ST
KUNA ID
83634-4894
US

IV. Provider business mailing address

1495 W FLUORITE ST
KUNA ID
83634-4894
US

V. Phone/Fax

Practice location:
  • Phone: 208-916-8638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY PASKI
Title or Position: OWNER
Credential:
Phone: 208-916-8638