Provider Demographics
NPI:1306521018
Name:S HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:S HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKO-MIKYENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-340-0953
Mailing Address - Street 1:617 S 13TH ST APT 413
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6838
Mailing Address - Country:US
Mailing Address - Phone:208-340-0953
Mailing Address - Fax:
Practice Address - Street 1:617 S 13TH ST APT 413
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6838
Practice Address - Country:US
Practice Address - Phone:208-340-0953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No251E00000XAgenciesHome Health