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General NPI Number Information
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NPI Number | 1750711362
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Entity Type | Organization
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Legal Business Name | ST. FILLAN'S, LLC
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 226 E 5TH ST
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City | MERIDIAN
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State | ID
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Zip | 83642-2774
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Country | US
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Telephone | 208-871-4552
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Fax | 208-855-0866
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Provider Business Mailing Address
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Address Line | 226 E 5TH ST
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City | MERIDIAN
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State | ID
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Zip | 83642-2774
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Country | US
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Telephone | 208-871-4552
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Fax | 208-855-0866
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MR. ANDREW VANDERBEEK
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Credential |
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Telephone | 208-871-4552
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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 | RHA-4979
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License Number State | ID
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