Healthcare Provider Details

I. General information

NPI: 1962273029
Provider Name (Legal Business Name): PERSONAL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 ELM ST
MACKAY ID
83251-7734
US

IV. Provider business mailing address

PO BOX 52
MACKAY ID
83251-0052
US

V. Phone/Fax

Practice location:
  • Phone: 208-588-2302
  • Fax:
Mailing address:
  • Phone: 208-588-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LORI PALMER
Title or Position: OWNER
Credential:
Phone: 208-588-2302