Healthcare Provider Details

I. General information

NPI: 1134899719
Provider Name (Legal Business Name): ALPOWA HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 MAIN ST STE 422
LEWISTON ID
83501-1869
US

IV. Provider business mailing address

504 MAIN ST STE 422
LEWISTON ID
83501-1869
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-2568
  • Fax: 509-758-3413
Mailing address:
  • Phone: 509-758-2568
  • Fax: 509-758-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER L TUELLER
Title or Position: SECRETARY
Credential:
Phone: 208-207-2726