Healthcare Provider Details

I. General information

NPI: 1750017810
Provider Name (Legal Business Name): CTSH CDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 4TH AVE STE D
POST FALLS ID
83854-7518
US

IV. Provider business mailing address

12810 E NORA AVE STE A
SPOKANE VALLEY WA
99216-1045
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-3545
  • 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
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: JAYNE FRASER
Title or Position: VICE PRESIDENT
Credential:
Phone: 509-340-3545