=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720711997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEAR HOME HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2022
-----------------------------------------------------
Last Update Date | 07/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2110 S PLATEAU DR
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83686-4706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-764-9193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2110 S PLATEAU DR
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83686-4706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-764-9193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VIRGINIA RAYANN SIMPSON
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 916-764-9193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------