Provider Demographics
NPI:1790546273
Name:INDEPENDENCE CARE OF IDAHO LLC
Entity Type:Organization
Organization Name:INDEPENDENCE CARE OF IDAHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF GOVERNMENT AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TROIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-520-1603
Mailing Address - Street 1:1016 COLLIER CENTER WAY STE 206
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-8473
Mailing Address - Country:US
Mailing Address - Phone:603-520-1603
Mailing Address - Fax:412-312-3828
Practice Address - Street 1:950 W BANNOCK ST STE 1100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6140
Practice Address - Country:US
Practice Address - Phone:603-520-1603
Practice Address - Fax:412-312-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care