Healthcare Provider Details

I. General information

NPI: 1306521018
Provider Name (Legal Business Name): S HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S SALTBRUSH WAY
MERIDIAN ID
83642-1113
US

IV. Provider business mailing address

2001 S SALTBRUSH WAY
MERIDIAN ID
83642-1113
US

V. Phone/Fax

Practice location:
  • Phone: 208-340-0953
  • Fax:
Mailing address:
  • Phone: 208-340-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL MIKO-MIKYENE
Title or Position: DIRECTOR
Credential: MD
Phone: 208-340-0953