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General NPI Number Information
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NPI Number | 1912575424
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Entity Type | Organization
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Legal Business Name | RJN BOISE, LLC
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Dates
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Enumeration Date | 06/12/2021
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Last Update Date | 06/12/2021
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Provider Practice Location Address
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Address Line | 2000 S PEPPERCORN PL
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City | BOISE
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State | ID
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Zip | 83709-2249
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Country | US
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Telephone | 208-409-8798
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 S PEPPERCORN PL
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City | BOISE
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State | ID
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Zip | 83709-2249
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Country | US
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Telephone | 208-409-8798
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | RANDALL JEROME NILSON
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Credential |
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Telephone | 208-409-8798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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