Provider Demographics
NPI:1689098964
Name:ASPEN MEADOWS HOME CARE LLC
Entity Type:Organization
Organization Name:ASPEN MEADOWS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMBLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:208-940-1350
Mailing Address - Street 1:104 SOUTH WARPATH
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467
Mailing Address - Country:US
Mailing Address - Phone:208-940-1350
Mailing Address - Fax:208-756-2903
Practice Address - Street 1:104 SOUTH WARPATH
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467
Practice Address - Country:US
Practice Address - Phone:208-940-1350
Practice Address - Fax:208-756-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA0001540Medicaid