MEDICARE: BOISE MEMORIAL HOSPICE LLC

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	251G00000X	Community Based Hospice Care Agency		ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144223900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOISE MEMORIAL HOSPICE LLC

Provider Business Mailing Address
First Line	:	600 E STATE ST
Second Line	:	SUITE 300
City	:	EAGLE
State	:	ID
Zip	:	83616-6081
Country	:	US
Telephone Number	:	208-938-4100
Fax Number	:	208-938-4564

Provider Business Practice Location Address
First Line	:	600 E STATE ST
Second Line	:	SUITE 300
City	:	EAGLE
State	:	ID
Zip	:	83616-6081
Country	:	US
Telephone Number	:	208-938-4100
Fax Number	:	208-938-4564

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	LAURIE KAY CAMPBELL
Credential	:
Telephone Number	:	208-938-4100

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/20/2009

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