Provider Demographics
NPI:1831182278
Name:MULTICARE HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:MULTICARE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-884-5497
Mailing Address - Street 1:324 S MERIDIAN RD
Mailing Address - Street 2:SUITE10
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2959
Mailing Address - Country:US
Mailing Address - Phone:208-884-5497
Mailing Address - Fax:208-887-6498
Practice Address - Street 1:324 S MERIDIAN RD
Practice Address - Street 2:SUITE10
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2959
Practice Address - Country:US
Practice Address - Phone:208-884-5497
Practice Address - Fax:208-887-6498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHH212251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805930400Medicaid
ID805930400Medicaid