Provider Demographics
NPI:1427356724
Name:SOUTHERN IDAHO HOME HEALTH & STAFFING
Entity Type:Organization
Organization Name:SOUTHERN IDAHO HOME HEALTH & STAFFING
Other - Org Name:BRIGHTSTAR OF SOUTH CENTRAL & EASTERN IDAHO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-733-8000
Mailing Address - Street 1:131 MAIN AVE E STE 1
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6229
Mailing Address - Country:US
Mailing Address - Phone:208-733-8000
Mailing Address - Fax:208-944-3398
Practice Address - Street 1:131 MAIN AVE E STE 1
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6229
Practice Address - Country:US
Practice Address - Phone:208-733-8000
Practice Address - Fax:208-944-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHH252251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health