MEDICARE: NORTHWEST BEC-CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HH-222	ID

General Provider Information

NPI Number	:	1003958125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST BEC-CORP

Provider Business Mailing Address
First Line	:	PO BOX 5986
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83303-5986
Country	:	US
Telephone Number	:	208-733-2234
Fax Number	:	208-733-2542

Provider Business Practice Location Address
First Line	:	300 2ND AVE E
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-6425
Country	:	US
Telephone Number	:	208-733-2234
Fax Number	:	208-733-2542

Authorized Official
Title or Position	:	OWNER
Name	:	DAN ADAMSON
Credential	:
Telephone Number	:	208-637-0999

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/19/2007

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