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General NPI Number Information
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NPI Number | 1417260563
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Entity Type | Organization
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Legal Business Name | IF HOSPICE OPCO LLC
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 197 STOCKHAM BLVD SUITE 2B
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City | RIGBY
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State | ID
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Zip | 83442-1275
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Country | US
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Telephone | 208-757-8444
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Fax | 208-965-8351
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Provider Business Mailing Address
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Address Line | PO BOX 1784
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City | IDAHO FALLS
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State | ID
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Zip | 83403-1784
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Country | US
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Telephone | 208-757-8444
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Fax | 208-965-8351
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Authorized Official
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Title or Position | CFO
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Name | MR. JUSTIN GREGORY
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Credential |
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Telephone | 208-346-7807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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