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General NPI Number Information
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NPI Number | 1093101735
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Entity Type | Organization
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Legal Business Name | BESTLIFE CARE, INC
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 525 POOLE AVE
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City | POCATELLO
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State | ID
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Zip | 83201-5021
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Country | US
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Telephone | 82-213-6822
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Fax | 208-417-0531
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Provider Business Mailing Address
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Address Line | 525 POOLE AVE
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City | POCATELLO
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State | ID
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Zip | 83201-5021
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Country | US
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Telephone | 208-221-3682
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Fax | 208-417-0531
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ROBERT DELOACH
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Credential |
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Telephone | 208-221-3682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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