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General NPI Number Information
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NPI Number | 1740674621
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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 | 03/27/2015
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Last Update Date | 03/27/2015
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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 | 208-941-8879
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Fax |
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Provider Business Mailing Address
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Address Line | 524 3RD ST S P.O. BOX 183
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City | NAMPA
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State | ID
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Zip | 83651-3720
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSEPH JAMES HAZEL
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Credential |
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Telephone | 208-941-8879
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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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