Provider Demographics
NPI:1063756781
Name:HYTECH REPAIR INC.
Entity type:Organization
Organization Name:HYTECH REPAIR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-870-9557
Mailing Address - Street 1:995 E LEIGHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1767
Mailing Address - Country:US
Mailing Address - Phone:208-870-9557
Mailing Address - Fax:208-884-0894
Practice Address - Street 1:995 E LEIGHFIELD DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1767
Practice Address - Country:US
Practice Address - Phone:208-870-9557
Practice Address - Fax:208-884-0894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HYTECH REPAIR INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRCE31200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health