1174845762 NPI number — HPA IDAHO, LLC

Table of content: (NPI 1174845762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174845762 NPI number — HPA IDAHO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HPA IDAHO, LLC
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:
HARRISON'S HOPE - TWIN FALLS
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:
1174845762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6303 COWBOYS WAY STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-0329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-535-8200
Provider Business Mailing Address Fax Number:
205-379-6720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 GOODING ST N STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-6177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-944-2021
Provider Business Practice Location Address Fax Number:
208-209-6069
Provider Enumeration Date:
02/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ENGLISH
Authorized Official First Name:
NORMA
Authorized Official Middle Name:
Authorized Official Title or Position:
HOSPICE DIVISION PRESIDENT
Authorized Official Telephone Number:
205-533-7216

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  NA , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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