Provider Demographics
NPI:1508517764
Name:WALSH, RICK JR (OWNER)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:WALSH
Suffix:JR
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3597 E MONARCH SKY LN STE 240
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1055
Mailing Address - Country:US
Mailing Address - Phone:208-893-6099
Mailing Address - Fax:
Practice Address - Street 1:3597 E MONARCH SKY LN STE 240
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1055
Practice Address - Country:US
Practice Address - Phone:208-893-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide