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General NPI Number Information
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NPI Number | 1659861227
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Entity Type | Organization
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Legal Business Name | ALLEGIANT HEALTH LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 210 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-5013
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Country | US
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Telephone | 208-466-0987
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Fax | 208-466-0985
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Provider Business Mailing Address
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Address Line | 210 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-5013
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Country | US
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Telephone | 208-466-0987
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Fax | 208-466-0985
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. TRACY LOUISE BERRY
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Credential |
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Telephone | 208-466-0987
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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 | 1740674621
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License Number State | ID
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