Provider Demographics
NPI:1568500544
Name:HOME TOUCH A CENTER FOR WELLNESS
Entity Type:Organization
Organization Name:HOME TOUCH A CENTER FOR WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-756-1710
Mailing Address - Street 1:1253 CEMETERY LN
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-5436
Mailing Address - Country:US
Mailing Address - Phone:208-756-1710
Mailing Address - Fax:208-756-1610
Practice Address - Street 1:1253 CEMETERY LN
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-5436
Practice Address - Country:US
Practice Address - Phone:208-756-1710
Practice Address - Fax:208-756-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID0310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDF40684Medicare UPIN
ID1376476Medicare ID - Type Unspecified