Provider Demographics
NPI:1174162986
Name:IDAHOME CAREGIVERS
Entity type:Organization
Organization Name:IDAHOME CAREGIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARISSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:NIECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-241-4226
Mailing Address - Street 1:3515 W GREENBRIER DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-4514
Mailing Address - Country:US
Mailing Address - Phone:208-241-4226
Mailing Address - Fax:
Practice Address - Street 1:3515 W GREENBRIER DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-4514
Practice Address - Country:US
Practice Address - Phone:208-241-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health