Provider Demographics
NPI:1932698586
Name:HEALTHY LIVING AT HOME-TWIN FALLS, LLC
Entity Type:Organization
Organization Name:HEALTHY LIVING AT HOME-TWIN FALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-260-5296
Mailing Address - Street 1:2950 E MAGIC VIEW DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6253
Mailing Address - Country:US
Mailing Address - Phone:208-949-7077
Mailing Address - Fax:208-493-3019
Practice Address - Street 1:2950 E MAGIC VIEW DR STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6253
Practice Address - Country:US
Practice Address - Phone:208-949-7077
Practice Address - Fax:208-493-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health