Provider Demographics
NPI:1093430704
Name:SE ID CAREGIVING LLC
Entity type:Organization
Organization Name:SE ID CAREGIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONTANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-240-8559
Mailing Address - Street 1:357 W CENTER ST STE 216A
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3236
Mailing Address - Country:US
Mailing Address - Phone:208-417-8070
Mailing Address - Fax:
Practice Address - Street 1:357 W CENTER ST STE 216A
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3236
Practice Address - Country:US
Practice Address - Phone:208-417-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty