Provider Demographics
NPI:1023004348
Name:HOME LIVING SERVICES INC
Entity type:Organization
Organization Name:HOME LIVING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TORI
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-232-9392
Mailing Address - Street 1:436 E BONNEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6406
Mailing Address - Country:US
Mailing Address - Phone:208-233-3466
Mailing Address - Fax:208-234-9686
Practice Address - Street 1:436 E BONNEVILLE ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6406
Practice Address - Country:US
Practice Address - Phone:208-233-3466
Practice Address - Fax:208-234-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1319LS3336L0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002721800Medicaid