Provider Demographics
NPI:1033768262
Name:CLOUDNINE HOME CARE LLC
Entity Type:Organization
Organization Name:CLOUDNINE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:BROOK
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-248-8166
Mailing Address - Street 1:482 CONSTITUTION WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3568
Mailing Address - Country:US
Mailing Address - Phone:208-552-0399
Mailing Address - Fax:
Practice Address - Street 1:482 CONSTITUTION WAY STE 110
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3568
Practice Address - Country:US
Practice Address - Phone:208-552-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA00003685Medicaid
IDA0003865Medicaid