Provider Demographics
NPI:1568563724
Name:HEALTHPRO HOME HEALTH LLC
Entity Type:Organization
Organization Name:HEALTHPRO HOME HEALTH LLC
Other - Org Name:HELPING HANDS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHYLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:208-232-2009
Mailing Address - Street 1:1308 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4702
Mailing Address - Country:US
Mailing Address - Phone:208-232-2009
Mailing Address - Fax:208-478-7555
Practice Address - Street 1:1308 E CENTER ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4702
Practice Address - Country:US
Practice Address - Phone:208-232-2009
Practice Address - Fax:208-478-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHH-199251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8062054Medicaid
ID137102Medicare ID - Type UnspecifiedPROVIDER NUMBER