Provider Demographics
NPI:1619351442
Name:HOMESTEAD HOME HEALTH & HOSPICE LLC
Entity Type:Organization
Organization Name:HOMESTEAD HOME HEALTH & HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-497-7384
Mailing Address - Street 1:360 W 3500 N
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3215
Mailing Address - Country:US
Mailing Address - Phone:208-497-7384
Mailing Address - Fax:
Practice Address - Street 1:407 W 1ST N
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1405
Practice Address - Country:US
Practice Address - Phone:208-497-7384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health