Healthcare Provider Details

I. General information

NPI: 1003958125
Provider Name (Legal Business Name): NORTHWEST BEC-CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE E
TWIN FALLS ID
83301-6425
US

IV. Provider business mailing address

PO BOX 5986
TWIN FALLS ID
83303-5986
US

V. Phone/Fax

Practice location:
  • Phone: 208-733-2234
  • Fax: 208-733-2542
Mailing address:
  • Phone: 208-733-2234
  • Fax: 208-733-2542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHH-222
License Number StateID

VIII. Authorized Official

Name: DAN ADAMSON
Title or Position: OWNER
Credential:
Phone: 208-637-0999