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General NPI Number Information
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NPI Number | 1396621850
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Entity Type | Organization
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Legal Business Name | MOMENTUM HOME HEALTH IDAHO LLC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 410 MEMORIAL DR STE 202
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3607
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Country | US
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Telephone | 208-480-1718
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Fax | 208-480-1737
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Provider Business Mailing Address
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Address Line | 410 MEMORIAL DR STE 202
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3607
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Country | US
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Telephone | 208-480-1718
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Fax | 208-480-1737
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Authorized Official
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Title or Position | ADMINISTRATOR/CLINICAL MANAGER
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Name | BRIDGER BOYD CARPENTER
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Credential | RN-BSN
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Telephone | 208-569-5389
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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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