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General NPI Number Information
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NPI Number | 1639536337
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Entity Type | Organization
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Legal Business Name | HOME HEALTH HOLDINGS, LLC
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3767 PROFESSIONAL WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83402-7315
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Country | US
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Telephone | 208-419-0896
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Fax | 208-419-0974
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Provider Business Mailing Address
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Address Line | 3767 PROFESSIONAL WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83402-7315
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Country | US
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Telephone | 208-419-0896
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Fax | 208-419-0974
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Authorized Official
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Title or Position | OWNER, OPERATOR
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Name | JACOB RAYMOND BRYAN
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Credential | M.O.T.
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Telephone | 208-270-6086
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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 | ID
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