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General NPI Number Information
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NPI Number | 1790470490
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Entity Type | Organization
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Legal Business Name | TRINITY MOUNTAIN HEALTH
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 6154 N MEEKER PL STE 150
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City | BOISE
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State | ID
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Zip | 83713-0211
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Country | US
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Telephone | 208-705-0879
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Fax |
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Provider Business Mailing Address
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Address Line | 440 CALLAWAY DR
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City | CHUBBUCK
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State | ID
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Zip | 83202-5079
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Country | US
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Telephone | 208-705-0879
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARIN KIRSTIN LACKEY
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Credential |
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Telephone | 208-705-0879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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