Provider Demographics
NPI:1588858559
Name:A FULL LIFE HOME HEALTH BOISE INC
Entity Type:Organization
Organization Name:A FULL LIFE HOME HEALTH BOISE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFINAY
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:HOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-765-8016
Mailing Address - Street 1:8601 W EMERALD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4810
Mailing Address - Country:US
Mailing Address - Phone:208-342-1222
Mailing Address - Fax:
Practice Address - Street 1:8601 W EMERALD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4810
Practice Address - Country:US
Practice Address - Phone:208-342-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health