1861533176 NPI number — A FULL LIFE HOME HEALTH LEWISTON 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 1861533176 NPI number — A FULL LIFE HOME HEALTH LEWISTON INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A FULL LIFE HOME HEALTH LEWISTON 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:
1861533176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 11TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83501-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-746-8881
Provider Business Mailing Address Fax Number:
208-746-5694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83501-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-746-8881
Provider Business Practice Location Address Fax Number:
208-746-5694
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRACKETT
Authorized Official First Name:
HOPE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
208-746-8881

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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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