Basic Information
| Provider Information | |||||||||
| NPI: | 1467772897 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLIANCE HOME HEALTH OF IDAHO, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALLIANCE HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 W 465 N | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843328003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357533133 | ||||||||
| FaxNumber: | 4357533542 | ||||||||
| Practice Location | |||||||||
| Address1: | 218 FALLS AVE | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087332234 | ||||||||
| FaxNumber: | 2087332542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2010 | ||||||||
| LastUpdateDate: | 06/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | LARSEN | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/ PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4357533133 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.