Provider Demographics
NPI:1770043689
Name:KIND HEART INC
Entity Type:Organization
Organization Name:KIND HEART INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-523-9119
Mailing Address - Street 1:2896 LIANNE ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-5638
Mailing Address - Country:US
Mailing Address - Phone:208-523-9119
Mailing Address - Fax:855-529-3924
Practice Address - Street 1:2896 LIANNE ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-5638
Practice Address - Country:US
Practice Address - Phone:208-523-9119
Practice Address - Fax:855-529-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID190840007Medicaid