MEDICARE: GEM HOME HEALTH

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	251E00000X	Home Health Agency	HH130	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010014860	OTHER	ID	REGENCE BLUE SHIELD
2	01818	OTHER	ID	BLUE CROSS

General Provider Information

NPI Number	:	1922007004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEM HOME HEALTH

Provider Business Mailing Address
First Line	:	1202 E LOCUST ST
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-2715
Country	:	US
Telephone Number	:	208-365-3561
Fax Number	:	208-365-4176

Provider Business Practice Location Address
First Line	:	1024 E LOCUST ST
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-2776
Country	:	US
Telephone Number	:	208-365-3561
Fax Number	:	208-365-4176

Authorized Official
Title or Position	:	CEO / ADMINISTRATOR
Name	:	MR. MAX LONG
Credential	:
Telephone Number	:	208-365-3561

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/22/2020

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Directions to “GEM HOME HEALTH ” Practice Location

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