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General NPI Number Information
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NPI Number | 1710430400
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Entity Type | Organization
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Legal Business Name | MAX4 INC DBA COMFORT KEEPERS 168
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 529 F ST SUITE D
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City | RUPERT
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State | ID
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Zip | 83350-1635
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Country | US
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Telephone | 208-434-8888
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Fax | 208-436-1970
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Provider Business Mailing Address
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Address Line | 529 F ST SUITE D
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City | RUPERT
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State | ID
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Zip | 83350-1635
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Country | US
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Telephone | 208-434-8888
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Fax | 208-436-1970
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Authorized Official
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Title or Position | OWNER/VICE PRESIDENT
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Name | ROBYN MAXFIELD
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Credential |
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Telephone | 208-434-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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