Provider Demographics
NPI:1023086493
Name:LIFES DOORS HOSPICE INC
Entity type:Organization
Organization Name:LIFES DOORS HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANGENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-344-6500
Mailing Address - Street 1:PO BOX 5754
Mailing Address - Street 2:420 S ORCHARD
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-0754
Mailing Address - Country:US
Mailing Address - Phone:208-344-6500
Mailing Address - Fax:208-344-6590
Practice Address - Street 1:420 S ORCHARD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-0754
Practice Address - Country:US
Practice Address - Phone:208-344-6500
Practice Address - Fax:208-344-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDH0143OtherBC
ID000010014564OtherBS
131516Medicare ID - Type Unspecified