Provider Demographics
NPI:1154454593
Name:SYRINGA GENERAL HOSPITAL DISTRICT HOME HEALTH
Entity Type:Organization
Organization Name:SYRINGA GENERAL HOSPITAL DISTRICT HOME HEALTH
Other - Org Name:SYRINGA GENERAL HOSPITAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-983-1700
Mailing Address - Street 1:607 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-1345
Mailing Address - Country:US
Mailing Address - Phone:208-983-1700
Mailing Address - Fax:208-983-8520
Practice Address - Street 1:607 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-1345
Practice Address - Country:US
Practice Address - Phone:208-983-1700
Practice Address - Fax:208-983-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-02-22
Deactivation Date:2009-11-23
Deactivation Code:
Reactivation Date:2010-02-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID81836OtherBLUE CROSS PROVIDER NUMBE
ID81836OtherBLUE CROSS PROVIDER NUMBE