MEDICARE: HOME LIVING SERVICES

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750576955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME LIVING SERVICES

Provider Business Mailing Address
First Line	:	436 E BONNEVILLE ST
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83201-6406
Country	:	US
Telephone Number	:	208-235-7250
Fax Number	:	208-235-7296

Provider Business Practice Location Address
First Line	:	106 S COLE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-0932
Country	:	US
Telephone Number	:	208-376-6810
Fax Number	:	208-376-6899

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DANIEL TORI SHAVER
Credential	:
Telephone Number	:	208-235-7243

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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Directions to “HOME LIVING SERVICES ” Practice Location

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