Provider Demographics
NPI:1407019482
Name:ADDUS HEALTHCARE (IDAHO), INC.
Entity Type:Organization
Organization Name:ADDUS HEALTHCARE (IDAHO), INC.
Other - Org Name:ADDUS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP, CHIEF STRATEGY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DARBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-3443
Mailing Address - Street 1:2300 WARRENVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1765
Mailing Address - Country:US
Mailing Address - Phone:630-296-3400
Mailing Address - Fax:630-487-2713
Practice Address - Street 1:415 W 9TH ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-1766
Practice Address - Country:US
Practice Address - Phone:406-293-9651
Practice Address - Fax:406-293-9706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDUS HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-09
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0681156Medicaid
MT4700075Medicaid