Provider Demographics
NPI:1194016196
Name:ONESOURCE PDH LLC
Entity Type:Organization
Organization Name:ONESOURCE PDH LLC
Other - Org Name:ONESOURCE PCS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-524-0685
Mailing Address - Street 1:1680 ELK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-1225
Mailing Address - Country:US
Mailing Address - Phone:208-524-0685
Mailing Address - Fax:208-524-0686
Practice Address - Street 1:1680 ELK CREEK DR STE 100
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-1225
Practice Address - Country:US
Practice Address - Phone:208-524-0685
Practice Address - Fax:208-524-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care