Provider Demographics
NPI:1710410378
Name:ALLEGIANT HEALTH LLC
Entity Type:Organization
Organization Name:ALLEGIANT HEALTH LLC
Other - Org Name:ALLEGIANT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-466-0987
Mailing Address - Street 1:210 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5013
Mailing Address - Country:US
Mailing Address - Phone:208-466-0987
Mailing Address - Fax:208-466-0985
Practice Address - Street 1:210 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5013
Practice Address - Country:US
Practice Address - Phone:208-466-0987
Practice Address - Fax:208-466-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1740674621253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8Q516 1740674621OtherBLUE CROSS
ID1740674621Medicaid