Basic Information
| Provider Information | |||||||||
| NPI: | 1720258668 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HELPING HANDS SANCTUARY OF IDAHO, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | HELPING HANDS OF GOODING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4837 | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832054837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082802163 | ||||||||
| FaxNumber: | 2089044030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 MONTANA ST | ||||||||
| Address2: | |||||||||
| City: | GOODING | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833301856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089345601 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2008 | ||||||||
| LastUpdateDate: | 03/06/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PRESCOTT | ||||||||
| AuthorizedOfficialFirstName: | BYRUM | ||||||||
| AuthorizedOfficialMiddleName: | ROY | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 2082802802163 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HELPING HANDS SANCTUARY OF IDAHO, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | C131521 | ID | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.