Provider Demographics
NPI:1508650060
Name:COMMUNITY LIVING OF IDAHO LLC
Entity type:Organization
Organization Name:COMMUNITY LIVING OF IDAHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:FAUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-906-4249
Mailing Address - Street 1:3424 STARLIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6647
Mailing Address - Country:US
Mailing Address - Phone:208-906-4249
Mailing Address - Fax:
Practice Address - Street 1:3424 STARLIGHT AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6647
Practice Address - Country:US
Practice Address - Phone:208-906-4249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care