Provider Demographics
NPI:1639536337
Name:HOME HEALTH HOLDINGS, LLC
Entity Type:Organization
Organization Name:HOME HEALTH HOLDINGS, LLC
Other - Org Name:AVALON HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MOT
Authorized Official - Phone:208-270-6086
Mailing Address - Street 1:3767 PROFESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-7315
Mailing Address - Country:US
Mailing Address - Phone:208-419-0896
Mailing Address - Fax:208-419-0974
Practice Address - Street 1:3767 PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-7315
Practice Address - Country:US
Practice Address - Phone:208-419-0896
Practice Address - Fax:208-419-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health