MEDICARE: EDEN HOSPICE AT IDAHO FALLS, 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

General Provider Information

NPI Number	:	1669839395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN HOSPICE AT IDAHO FALLS, LLC

Provider Business Mailing Address
First Line	:	4601 NE 77TH AVE STE 300
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6736
Country	:	US
Telephone Number	:	360-892-6628
Fax Number	:	360-882-5793

Provider Business Practice Location Address
First Line	:	2540 CHANNING WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7515
Country	:	US
Telephone Number	:	208-523-1980
Fax Number	:

Authorized Official
Title or Position	:	CEO AND MANAGER
Name	:	BRENT WEIL
Credential	:
Telephone Number	:	360-892-6628

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	02/18/2026

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