Provider Demographics
NPI:1063587509
Name:ALLIANCE HOME HEALTH OF IDAHO, LLC
Entity type:Organization
Organization Name:ALLIANCE HOME HEALTH OF IDAHO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-753-3133
Mailing Address - Street 1:353 N 4TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6390
Mailing Address - Country:US
Mailing Address - Phone:208-478-2291
Mailing Address - Fax:208-478-1363
Practice Address - Street 1:353 N 4TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6390
Practice Address - Country:US
Practice Address - Phone:208-478-2291
Practice Address - Fax:208-478-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health