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

General Provider Information

NPI Number	:	1740674621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGIANT HEALTH LLC

Provider Business Mailing Address
First Line	:	524 3RD ST S
Second Line	:	P.O. BOX 183
City	:	NAMPA
State	:	ID
Zip	:	83651-3720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5013
Country	:	US
Telephone Number	:	208-941-8879
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSEPH JAMES HAZEL
Credential	:
Telephone Number	:	208-941-8879

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	03/27/2015

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Directions to “ALLEGIANT HEALTH LLC ” Practice Location

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