Healthcare Provider Details

I. General information

NPI: 1285170050
Provider Name (Legal Business Name): PROHEALTH HOME CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 E CENTER ST
POCATELLO ID
83201-5702
US

IV. Provider business mailing address

936 E CENTER ST
POCATELLO ID
83201-5702
US

V. Phone/Fax

Practice location:
  • Phone: 208-235-6565
  • Fax: 208-235-7624
Mailing address:
  • Phone: 208-235-6565
  • Fax: 208-235-7624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WANDA JEAN ANDREWS
Title or Position: DIRECTOR OF NURSING
Credential: RN
Phone: 208-235-6565