Healthcare Provider Details

I. General information

NPI: 1689996357
Provider Name (Legal Business Name): TETON HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 W WILLOWBROOK DR
MERIDIAN ID
83646-1656
US

IV. Provider business mailing address

63 W WILLOWBROOK DR
MERIDIAN ID
83646-1656
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-7877
  • Fax: 208-888-7987
Mailing address:
  • Phone: 208-888-7877
  • Fax: 208-888-7987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateID

VIII. Authorized Official

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