Provider Demographics
NPI:1710430400
Name:MAX4 INC DBA COMFORT KEEPERS 168
Entity Type:Organization
Organization Name:MAX4 INC DBA COMFORT KEEPERS 168
Other - Org Name:COMFORT KEEPERS 168
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-434-8888
Mailing Address - Street 1:529 F ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1635
Mailing Address - Country:US
Mailing Address - Phone:208-434-8888
Mailing Address - Fax:208-436-1970
Practice Address - Street 1:529 F ST
Practice Address - Street 2:SUITE D
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1635
Practice Address - Country:US
Practice Address - Phone:208-434-8888
Practice Address - Fax:208-436-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8060879Medicaid
IDM8060882Medicaid