Healthcare Provider Details

I. General information

NPI: 1154593747
Provider Name (Legal Business Name): COMPCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 126TH ST STE B
OROFINO ID
83544-5016
US

IV. Provider business mailing address

150 126TH ST STE B
OROFINO ID
83544-5016
US

V. Phone/Fax

Practice location:
  • Phone: 208-476-3714
  • Fax: 208-476-5635
Mailing address:
  • Phone: 208-476-3714
  • Fax: 208-476-5635

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateID

VIII. Authorized Official

Name: MR. GERALD LEE HOSLEY SR.
Title or Position: OWNER
Credential:
Phone: 208-476-3714