1043215395 NPI number — HORIZON HOME HEALTH & HOSPICE, INC.

Table of content: (NPI 1043215395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043215395 NPI number — HORIZON HOME HEALTH & HOSPICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORIZON HOME HEALTH & HOSPICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043215395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 N LINDER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83642-8501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-888-7877
Provider Business Mailing Address Fax Number:
208-888-7987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 N LINDER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83642-8501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-888-7877
Provider Business Practice Location Address Fax Number:
208-888-7987
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLE
Authorized Official First Name:
MARCELLA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
208-888-7877

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HH-139 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251G00000X , with the licence number: N/A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002762900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043215395 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02543 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010014777 . This is a "BLUE SHIELD PROVIDER #" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002726300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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