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General NPI Number Information
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NPI Number | 1235231002
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Entity Type | Organization
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Legal Business Name | ADDERSON HEALTHCARE OF IDAHO, INC.
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1167 W CRESCENT ST
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City | MERIDIAN
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State | ID
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Zip | 83642-2620
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Country | US
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Telephone | 208-895-0033
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Fax | 208-895-0033
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Provider Business Mailing Address
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Address Line | 1167 W CRESCENT ST
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City | MERIDIAN
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State | ID
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Zip | 83642-2620
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Country | US
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Telephone | 208-895-0033
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Fax | 208-895-0033
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. DALE GENE PFEIL
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Credential |
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Telephone | 208-895-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | ID
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