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General NPI Number Information
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NPI Number | 1063047470
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Entity Type | Organization
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Legal Business Name | NORTHSTAR IN HOME SUPPORT SERVICES
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 3323 EAST B 3600 NORTH
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City | KIMBERLY
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State | ID
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Zip | 83341
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Country | US
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Telephone | 208-420-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 3323 EAST B 3600 NORTH
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City | KIMBERLY
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State | ID
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Zip | 83341
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Country | US
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Telephone | 208-420-4663
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KOREY LYNN SOLOMON
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Credential | LSW
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Telephone | 208-420-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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