Provider Demographics
NPI:1669839395
Name:EDEN HOSPICE AT IDAHO FALLS, LLC
Entity Type:Organization
Organization Name:EDEN HOSPICE AT IDAHO FALLS, LLC
Other - Org Name:EDEN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-892-6628
Mailing Address - Street 1:4601 NE 77TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6729
Mailing Address - Country:US
Mailing Address - Phone:360-892-6628
Mailing Address - Fax:360-882-5793
Practice Address - Street 1:1480 MIDWAY AVE
Practice Address - Street 2:UNIT 7
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4587
Practice Address - Country:US
Practice Address - Phone:208-523-1980
Practice Address - Fax:208-529-4013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPRES HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-26
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based