Provider Demographics
NPI:1962622019
Name:COMMUNICARE, INC
Entity type:Organization
Organization Name:COMMUNICARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHITTEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-888-1155
Mailing Address - Street 1:40 W FRANKLIN RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2965
Mailing Address - Country:US
Mailing Address - Phone:208-888-1155
Mailing Address - Fax:208-888-1156
Practice Address - Street 1:40 W FRANKLIN RD
Practice Address - Street 2:SUITE F
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2965
Practice Address - Country:US
Practice Address - Phone:208-888-1155
Practice Address - Fax:208-888-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID000261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8050209Medicaid