Provider Demographics
NPI:1699593376
Name:HOSPICE OF EASTERN IDAHO, INC.
Entity type:Organization
Organization Name:HOSPICE OF EASTERN IDAHO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-529-0342
Mailing Address - Street 1:1810 MORAN ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4337
Mailing Address - Country:US
Mailing Address - Phone:208-529-0342
Mailing Address - Fax:208-529-6981
Practice Address - Street 1:1810 MORAN ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4337
Practice Address - Country:US
Practice Address - Phone:208-529-0342
Practice Address - Fax:208-529-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based