Healthcare Provider Details

I. General information

NPI: 1922030352
Provider Name (Legal Business Name): HEARTHSIDE HOME HEALTH AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LEADORE AVE
SALMON ID
83467-3622
US

IV. Provider business mailing address

1403 LEADORE AVE
SALMON ID
83467-3622
US

V. Phone/Fax

Practice location:
  • Phone: 208-756-6383
  • Fax: 208-756-1312
Mailing address:
  • Phone: 208-756-6383
  • Fax: 208-756-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHH-135
License Number StateID

VIII. Authorized Official

Name: MRS. HANNA VERMAAS
Title or Position: ADMINISTATOR OWNER
Credential: RN/BSN
Phone: 209-756-6383