Provider Demographics
NPI:1831827310
Name:EROS HEALTH, LLC
Entity type:Organization
Organization Name:EROS HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MIMISH
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, WHNP
Authorized Official - Phone:208-559-6494
Mailing Address - Street 1:1301 S MILLSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-4837
Mailing Address - Country:US
Mailing Address - Phone:208-559-6494
Mailing Address - Fax:
Practice Address - Street 1:800 W MAIN ST STE 1460
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5983
Practice Address - Country:US
Practice Address - Phone:208-352-2290
Practice Address - Fax:833-471-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty