Basic Information
| Provider Information | |||||||||
| NPI: | 1568980985 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACHS HOSPICE & PALLITIVE CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CARING EDGE O P | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 S BRIDGE WAY PL STE 122 | ||||||||
| Address2: | |||||||||
| City: | EAGLE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836166022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084732717 | ||||||||
| FaxNumber: | 8778905617 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 S BRIDGE WAY PL STE 122 | ||||||||
| Address2: | |||||||||
| City: | EAGLE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836166022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084732717 | ||||||||
| FaxNumber: | 8778905617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LOUGHEED | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PT/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2084732717 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-3215 | ID | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT-3215 | 01 | ID | ID LICENSE | OTHER |