Provider Demographics
NPI:1336932656
Name:LV RUSSELL HOME CARE LLC
Entity type:Organization
Organization Name:LV RUSSELL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:VALLEJO RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-714-7024
Mailing Address - Street 1:2187 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5768
Mailing Address - Country:US
Mailing Address - Phone:208-714-7024
Mailing Address - Fax:
Practice Address - Street 1:2187 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5768
Practice Address - Country:US
Practice Address - Phone:208-714-7024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care