Provider Demographics
NPI:1598768483
Name:NORTH IDAHO HOME HEALTH
Entity Type:Organization
Organization Name:NORTH IDAHO HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:MCKERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-667-7494
Mailing Address - Street 1:2426 N MERRIT CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4961
Mailing Address - Country:US
Mailing Address - Phone:208-667-7494
Mailing Address - Fax:208-765-2236
Practice Address - Street 1:2426 N MERRIT CREEK LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4961
Practice Address - Country:US
Practice Address - Phone:208-667-7494
Practice Address - Fax:208-765-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHH159251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID137019Medicare ID - Type Unspecified