Provider Demographics
NPI:1023409679
Name:ABODE H4H, LLC
Entity type:Organization
Organization Name:ABODE H4H, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-576-0087
Mailing Address - Street 1:503 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5200
Mailing Address - Country:US
Mailing Address - Phone:208-552-1177
Mailing Address - Fax:
Practice Address - Street 1:503 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5200
Practice Address - Country:US
Practice Address - Phone:208-552-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHH-260251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health