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General NPI Number Information
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NPI Number | 1770043689
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Entity Type | Organization
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Legal Business Name | KIND HEART INC
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 2896 LIANNE ST
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City | IDAHO FALLS
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State | ID
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Zip | 83402-5638
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Country | US
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Telephone | 208-523-9119
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Fax | 855-529-3924
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Provider Business Mailing Address
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Address Line | 2896 LIANNE ST
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City | IDAHO FALLS
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State | ID
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Zip | 83402-5638
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Country | US
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Telephone | 208-523-9119
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Fax | 855-529-3924
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANA R DAVIS
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Credential |
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Telephone | 208-523-9119
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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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