Provider Demographics
NPI:1366686826
Name:ADVANCED HOME HEALTH AND HOSPICE
Entity Type:Organization
Organization Name:ADVANCED HOME HEALTH AND HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-346-7807
Mailing Address - Street 1:850 ENERGY PL STE 1
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-1502
Mailing Address - Country:US
Mailing Address - Phone:208-346-7807
Mailing Address - Fax:208-346-7790
Practice Address - Street 1:850 ENERGY PL STE 1
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-1502
Practice Address - Country:US
Practice Address - Phone:208-346-7807
Practice Address - Fax:208-346-7790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-30834251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1366686826Medicaid