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General NPI Number Information
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NPI Number | 1063752574
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Entity Type | Organization
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Legal Business Name | IDAHO IN-HOME HEALTH & SOCIAL SERVICES LLC
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Dates
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Enumeration Date | 02/20/2013
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 37 W SUNSET CIR
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City | REXBURG
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State | ID
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Zip | 83440-9685
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Country | US
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Telephone | 775-253-5609
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Fax |
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Provider Business Mailing Address
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Address Line | 37 W SUNSET CIR
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City | REXBURG
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State | ID
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Zip | 83440-9685
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Country | US
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Telephone | 775-253-5609
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | MR. GARTH R OAKEY
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Credential |
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Telephone | 775-253-5609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | ID
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