1487780037 NPI number — NORTH IDAHO WORKER CARE

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 1487780037 NPI number — NORTH IDAHO WORKER CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH IDAHO WORKER CARE
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:
1487780037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
927 E POLSTON AVE
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
POST FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83854-9811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-664-3313
Provider Business Mailing Address Fax Number:
208-664-2793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 N SYRINGA ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-5275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-9110
Provider Business Practice Location Address Fax Number:
208-777-0717
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
K
Authorized Official Title or Position:
BUSINESS DIRECTOR
Authorized Official Telephone Number:
208-664-3313

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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