Healthcare Provider Details

I. General information

NPI: 1235892597
Provider Name (Legal Business Name): COEUR D ALENE ID CAREGIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 N IDAHO ST STE 1
POST FALLS ID
83854-9024
US

IV. Provider business mailing address

2612 WASHINGTON AVE STE 1
WACO TX
76710-7469
US

V. Phone/Fax

Practice location:
  • Phone: 818-926-0821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHEAL HILLMAN
Title or Position: OWNER
Credential:
Phone: 254-400-2625