Provider Demographics
NPI:1013317064
Name:COMPLETE HOSPICE CARE OF BOISE LLC
Entity Type:Organization
Organization Name:COMPLETE HOSPICE CARE OF BOISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:IGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-391-2724
Mailing Address - Street 1:7558 W THUNDERBIRD RD # 493
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6080
Mailing Address - Country:US
Mailing Address - Phone:208-391-2724
Mailing Address - Fax:888-858-4402
Practice Address - Street 1:1940 S BONITO WAY STE 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2625
Practice Address - Country:US
Practice Address - Phone:208-391-2724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID131572Medicare Oscar/Certification