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General NPI Number Information
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NPI Number | 1861146532
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Entity Type | Organization
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Legal Business Name | THEKEY OF IDAHO LLC
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 3597 E MONARCH SKY LN STE 240
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City | MERIDIAN
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State | ID
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Zip | 83646-1055
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Country | US
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Telephone | 208-252-6138
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Fax |
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Provider Business Mailing Address
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Address Line | 7777 FAY AVE
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City | LA JOLLA
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State | CA
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Zip | 92037-4327
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Country | US
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Telephone | 877-958-2562
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE ASSOCIATE
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Name | SEAN MICHELE CYGAN
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Credential |
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Telephone | 858-287-3077
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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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