Provider Demographics
NPI:1932891611
Name:INDIANHEAD BUSINESS LLC
Entity Type:Organization
Organization Name:INDIANHEAD BUSINESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NISSA
Authorized Official - Middle Name:NASIR
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-606-0550
Mailing Address - Street 1:590 W INDIANHEAD RD
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-1512
Mailing Address - Country:US
Mailing Address - Phone:214-606-0550
Mailing Address - Fax:
Practice Address - Street 1:590 W INDIANHEAD RD
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-1512
Practice Address - Country:US
Practice Address - Phone:214-606-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility