1720258668 NPI number — HELPING HANDS SANCTUARY OF IDAHO, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720258668 NPI number — HELPING HANDS SANCTUARY OF IDAHO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HELPING HANDS SANCTUARY OF IDAHO, 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:
6
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:
1720258668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4837
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83205-4837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-280-2163
Provider Business Mailing Address Fax Number:
208-904-4030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 MONTANA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOODING
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83330-1856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-934-5601
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PRESCOTT
Authorized Official First Name:
BYRUM
Authorized Official Middle Name:
ROY
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
2082802802163

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  C131521 , 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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