Basic Information
| Provider Information | |||||||||
| NPI: | 1528225729 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED HOME HEALTH & STAFFING INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 2ND STREET SO. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NAMPA | ||||||||
| State: | IDAHO | ||||||||
| PostalCode: | 83651 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 2084680140 | ||||||||
| FaxNumber: | 2084660580 | ||||||||
| Practice Location | |||||||||
| Address1: | 8030 W EMERALD ST | ||||||||
| Address2: | SUITE 185 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837049060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083217896 | ||||||||
| FaxNumber: | 2083218065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 05/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | DAHM | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2084680140 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 806183300 | 05 | ID | MEDICAID |