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General NPI Number Information
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NPI Number | 1871055152
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Entity Type | Organization
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Legal Business Name | 3 AND 1, LLC
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Dates
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Enumeration Date | 04/04/2019
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 1900 NORTHWEST BLVD STE 110
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2788
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Country | US
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Telephone | 208-758-8090
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Fax | 208-214-3222
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Provider Business Mailing Address
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Address Line | 1900 NORTHWEST BLVD STE 110
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2788
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Country | US
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Telephone | 208-758-8090
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Fax | 208-214-3222
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Authorized Official
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Title or Position | PART OWNER
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Name | MATT ZASTROW
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Credential |
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Telephone | 208-758-8090
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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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