Provider Demographics
NPI:1831466002
Name:TETON HOSPICE
Entity Type:Organization
Organization Name:TETON HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-529-3636
Mailing Address - Street 1:2470 JAFER COURT
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7575
Mailing Address - Country:US
Mailing Address - Phone:208-529-3636
Mailing Address - Fax:
Practice Address - Street 1:2470 JAFER COURT
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7575
Practice Address - Country:US
Practice Address - Phone:208-529-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based