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General NPI Number Information
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NPI Number | 1053017863
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Entity Type | Organization
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Legal Business Name | NEPENTHE, LLC
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 308 E 35TH ST
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City | GARDEN CITY
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State | ID
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Zip | 83714-6515
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Country | US
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Telephone | 208-371-2703
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Fax |
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Provider Business Mailing Address
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Address Line | 308 E 35TH ST
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City | GARDEN CITY
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State | ID
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Zip | 83714-6515
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Country | US
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Telephone | 208-371-2703
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KIMBERLY SPEARS
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Credential | NP
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Telephone | 208-371-2703
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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 |
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License Number State |
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