Provider Demographics
NPI:1063047470
Name:NORTHSTAR IN HOME SUPPORT SERVICES
Entity type:Organization
Organization Name:NORTHSTAR IN HOME SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KOREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:208-420-4663
Mailing Address - Street 1:3323 EAST B 3600 NORTH
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341
Mailing Address - Country:US
Mailing Address - Phone:208-420-4663
Mailing Address - Fax:
Practice Address - Street 1:3323 EAST B 3600 NORTH
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341
Practice Address - Country:US
Practice Address - Phone:208-420-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty