Healthcare Provider Details

I. General information

NPI: 1245451251
Provider Name (Legal Business Name): ADDUS HEALTHCARE (IDAHO), INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037A 21ST ST
LEWISTON ID
83501-3415
US

IV. Provider business mailing address

2300 WARRENVILLE RD SUITE 100
DOWNERS GROVE IL
60515-1765
US

V. Phone/Fax

Practice location:
  • Phone: 208-746-8881
  • Fax: 855-808-6973
Mailing address:
  • Phone: 630-296-3400
  • Fax: 630-487-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE KUMARICH
Title or Position: NATIONAL CONTRACTS
Credential: RN, MS, MBA
Phone: 630-296-3400