Provider Demographics
NPI:1477177921
Name:WHITEWATER HEALTHCARE LLC
Entity Type:Organization
Organization Name:WHITEWATER HEALTHCARE LLC
Other - Org Name:SYMBII HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:240 W BURNSIDE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-4703
Mailing Address - Country:US
Mailing Address - Phone:208-233-2279
Mailing Address - Fax:
Practice Address - Street 1:240 W BURNSIDE AVE STE B
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-4703
Practice Address - Country:US
Practice Address - Phone:086-372-2732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health