MEDICARE: ALLEGIANT HEALTH 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	253Z00000X	In Home Supportive Care Agency	1740674621	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8Q516 1740674621	OTHER	ID	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710410378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGIANT HEALTH LLC

Provider Business Mailing Address
First Line	:	210 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5013
Country	:	US
Telephone Number	:	208-466-0987
Fax Number	:	208-466-0985

Provider Business Practice Location Address
First Line	:	210 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5013
Country	:	US
Telephone Number	:	208-466-0987
Fax Number	:	208-466-0985

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	NICOLE SMITH
Credential	:
Telephone Number	:	208-466-0987

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	04/10/2017

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Directions to “ALLEGIANT HEALTH LLC ” Practice Location

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