Provider Demographics
NPI:1750012399
Name:AMBITIONS OF IDAHO, INC
Entity Type:Organization
Organization Name:AMBITIONS OF IDAHO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-676-9395
Mailing Address - Street 1:1044 NORTHWEST BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2165
Mailing Address - Country:US
Mailing Address - Phone:208-676-9395
Mailing Address - Fax:208-676-9385
Practice Address - Street 1:1019 W SANETTA ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-5047
Practice Address - Country:US
Practice Address - Phone:208-505-9076
Practice Address - Fax:208-505-9077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBITIONS OF IDAHO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health