Provider Demographics
NPI:1558787341
Name:ALL CARE HEALTH SOLUTIONS-PCS DIVISIONLLC
Entity Type:Organization
Organization Name:ALL CARE HEALTH SOLUTIONS-PCS DIVISIONLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-6364
Mailing Address - Street 1:815 S BRIDGEWAY PLACE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616
Mailing Address - Country:US
Mailing Address - Phone:208-371-6364
Mailing Address - Fax:208-344-3502
Practice Address - Street 1:815 S BRIDGE WAY PL
Practice Address - Street 2:SUITE 122
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6006
Practice Address - Country:US
Practice Address - Phone:208-371-6364
Practice Address - Fax:208-344-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========OtherEIN