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General NPI Number Information
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NPI Number | 1023409679
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Entity Type | Organization
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Legal Business Name | ABODE H4H, LLC
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 503 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-5200
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Country | US
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Telephone | 208-552-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 503 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-5200
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Country | US
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Telephone | 208-552-1177
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. DAVID KOSLOFF
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Credential |
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Telephone | 206-576-0087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HH-260
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License Number State | ID
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