Basic Information
| Provider Information | |||||||||
| NPI: | 1114317153 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HPA IDAHO, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HARRISON'S HOPE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3021 LORNA RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352164587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055337216 | ||||||||
| FaxNumber: | 2053796720 | ||||||||
| Practice Location | |||||||||
| Address1: | 3137 S MERIDIAN RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836427094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089476800 | ||||||||
| FaxNumber: | 2089476806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2015 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | ENGLISH | ||||||||
| AuthorizedOfficialFirstName: | NORMA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | HOSPICE DIVISION PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2055337216 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.