Provider Demographics
NPI:1285229039
Name:PROHEALTH
Entity Type:Organization
Organization Name:PROHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-241-1598
Mailing Address - Street 1:88 CEDAR HILLS DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4400
Mailing Address - Country:US
Mailing Address - Phone:208-241-1598
Mailing Address - Fax:
Practice Address - Street 1:808 N 8TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5718
Practice Address - Country:US
Practice Address - Phone:208-241-1598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care