Provider Demographics
NPI:1114637006
Name:COMMUNITY NURSING SERVICE
Entity Type:Organization
Organization Name:COMMUNITY NURSING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:LANECE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-233-6100
Mailing Address - Street 1:2830 S REDWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-5626
Mailing Address - Country:US
Mailing Address - Phone:801-639-5455
Mailing Address - Fax:
Practice Address - Street 1:1810 MORAN ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4337
Practice Address - Country:US
Practice Address - Phone:208-529-0342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health