Healthcare Provider Details

I. General information

NPI: 1235407420
Provider Name (Legal Business Name): HOMESTYLE DIRECT LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 HIGHLAND AVE E
TWIN FALLS ID
83301-7926
US

IV. Provider business mailing address

2032 HIGHLAND AVE E
TWIN FALLS ID
83301-7926
US

V. Phone/Fax

Practice location:
  • Phone: 866-735-0921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: JAMES KENDRICK GRIFFITH
Title or Position: CONTRACT MANAGER
Credential:
Phone: 208-631-2106