Healthcare Provider Details

I. General information

NPI: 1861896987
Provider Name (Legal Business Name): CC HOME HEALTH CHOICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 COURTHOUSE DR
SALMON ID
83467-3341
US

IV. Provider business mailing address

404 COURTHOUSE DR
SALMON ID
83467-3341
US

V. Phone/Fax

Practice location:
  • Phone: 208-993-8050
  • Fax: 208-993-8046
Mailing address:
  • Phone: 208-993-8050
  • Fax: 801-337-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CINDY L CLARK
Title or Position: OWNER
Credential: RN
Phone: 208-993-3479