Provider Demographics
NPI:1083045132
Name:ASSISTING HANDS HOME CARE - BOISE, LLC
Entity Type:Organization
Organization Name:ASSISTING HANDS HOME CARE - BOISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-442-8588
Mailing Address - Street 1:5700 E FRANKLIN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7900
Mailing Address - Country:US
Mailing Address - Phone:208-442-8588
Mailing Address - Fax:
Practice Address - Street 1:5700 E FRANKLIN RD STE 105
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7900
Practice Address - Country:US
Practice Address - Phone:208-442-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THREE AMIGOS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8075712Medicaid
OR500651939Medicaid