Basic Information
| Provider Information | |||||||||
| NPI: | 1003958125 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHWEST BEC-CORP | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5986 | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833035986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087332234 | ||||||||
| FaxNumber: | 2087332542 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 2ND AVE E | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833016425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087332234 | ||||||||
| FaxNumber: | 2087332542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | ADAMSON | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2086370999 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HH-222 | ID | Y | Agencies | Home Health |
No ID Information.