Provider Demographics
NPI:1457858052
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:ADMINISTRATOR
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:PO BOX 1784
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-1784
Mailing Address - Country:US
Mailing Address - Phone:208-346-7807
Mailing Address - Fax:208-346-7790
Practice Address - Street 1:444 HOSPITAL WAY STE 223
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2742
Practice Address - Country:US
Practice Address - Phone:208-269-1200
Practice Address - Fax:208-269-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDIDTPID004019Medicaid