Provider Demographics
NPI:1386188191
Name:CANYON IDAHO HOME CARE & HOSPICE, LLC
Entity type:Organization
Organization Name:CANYON IDAHO HOME CARE & HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-485-6166
Mailing Address - Street 1:450 S 900 E
Mailing Address - Street 2:STE. 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2981
Mailing Address - Country:US
Mailing Address - Phone:801-485-6166
Mailing Address - Fax:801-531-1949
Practice Address - Street 1:929 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2256
Practice Address - Country:US
Practice Address - Phone:208-642-1838
Practice Address - Fax:888-572-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based