MEDICARE: LOVING HEARTS PHC

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	203	ID

General Provider Information

NPI Number	:	1932513256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING HEARTS PHC

Provider Business Mailing Address
First Line	:	66 S CENTER ST
Second Line	:
City	:	WESTON
State	:	ID
Zip	:	83286-5010
Country	:	US
Telephone Number	:	208-380-5405
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 S CENTER ST
Second Line	:
City	:	WESTON
State	:	ID
Zip	:	83286-5010
Country	:	US
Telephone Number	:	208-380-5405
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MRS. LESLEE GRAVES
Credential	:	LPN
Telephone Number	:	208-380-5383

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	06/13/2014

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Directions to “LOVING HEARTS PHC ” Practice Location

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