Provider Demographics
NPI:1659799567
Name:ROCKY MOUNTAIN HOME HEALTH AND HOSPICE
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN HOME HEALTH AND HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBB
Authorized Official - Middle Name:
Authorized Official - Last Name:REDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-604-0098
Mailing Address - Street 1:732 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3748
Mailing Address - Country:US
Mailing Address - Phone:208-604-0098
Mailing Address - Fax:208-637-1577
Practice Address - Street 1:732 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3748
Practice Address - Country:US
Practice Address - Phone:208-604-0098
Practice Address - Fax:208-637-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW - 26140251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based