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General NPI Number Information
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NPI Number | 1548594328
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Entity Type | Organization
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Legal Business Name | HOME AGAIN ICF
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 2311 E ARUBA AVE
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City | NAMPA
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State | ID
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Zip | 83686-1292
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Country | US
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Telephone | 208-461-3203
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Fax | 208-461-3203
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Provider Business Mailing Address
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Address Line | 2311 ARUBA DR
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City | NAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 208-461-3203
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Fax | 208-461-3203
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. HEATHER LYN DAVIS
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Credential |
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Telephone | 208-863-1846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 78
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License Number State | ID
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