Healthcare Provider Details

I. General information

NPI: 1487251518
Provider Name (Legal Business Name): IN-HOME CARE OF MCCALL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 HEINRICH LN
MCCALL ID
83638-5091
US

IV. Provider business mailing address

PO BOX 4374
MCCALL ID
83638-8374
US

V. Phone/Fax

Practice location:
  • Phone: 208-315-3208
  • Fax:
Mailing address:
  • Phone: 208-315-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: RUTH KENNEDY
Title or Position: OWNER
Credential: MA
Phone: 208-315-3208