Provider Demographics
NPI:1952304099
Name:PUBLIC HEALTH DISTRICT 1
Entity Type:Organization
Organization Name:PUBLIC HEALTH DISTRICT 1
Other - Org Name:PANHANDLE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-415-5163
Mailing Address - Street 1:8500 N ATLAS RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7677
Mailing Address - Country:US
Mailing Address - Phone:208-415-5160
Mailing Address - Fax:208-415-5161
Practice Address - Street 1:8500 N ATLAS RD
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-7677
Practice Address - Country:US
Practice Address - Phone:208-415-5160
Practice Address - Fax:208-415-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHH-164251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002470700Medicaid
ID137002Medicare ID - Type UnspecifiedHOME HEALTH