Healthcare Provider Details

I. General information

NPI: 1023927084
Provider Name (Legal Business Name): KELLY CASE MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REMOTE
REXBURG ID
83440
US

IV. Provider business mailing address

1999 S 25TH E # 1011
AMMON ID
83406-5710
US

V. Phone/Fax

Practice location:
  • Phone: 208-410-8695
  • Fax:
Mailing address:
  • Phone: 208-410-8695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: CODY J. KELLY
Title or Position: OWNER/FOUNDER
Credential:
Phone: 208-410-8695