1154454593 NPI number — SYRINGA GENERAL HOSPITAL DISTRICT HOME HEALTH

Table of content: (NPI 1154454593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154454593 NPI number — SYRINGA GENERAL HOSPITAL DISTRICT HOME HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYRINGA GENERAL HOSPITAL DISTRICT HOME HEALTH
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:
SYRINGA GENERAL HOSPITAL HOME HEALTH
Provider Other Organization Name Type Code:
3
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:
1154454593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/23/2009
NPI Reactivation Date:
02/22/2010

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANGEVILLE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83530-1345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-983-1700
Provider Business Mailing Address Fax Number:
208-983-8520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANGEVILLE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83530-1345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-983-1700
Provider Business Practice Location Address Fax Number:
208-983-8520
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
208-983-1700

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 81836 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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