Provider Demographics
NPI:1760176499
Name:HIS LOVE
Entity Type:Organization
Organization Name:HIS LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISOLITHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-392-5135
Mailing Address - Street 1:1828 E SERCHIO CT
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6596
Mailing Address - Country:US
Mailing Address - Phone:208-392-5135
Mailing Address - Fax:
Practice Address - Street 1:1828 E SERCHIO CT
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6596
Practice Address - Country:US
Practice Address - Phone:208-392-5135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health