Provider Demographics
NPI:1962799031
Name:REDDOOR PERSONAL CARE
Entity type:Organization
Organization Name:REDDOOR PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:208-354-3005
Mailing Address - Street 1:215 E LITTLE AVE
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-5137
Mailing Address - Country:US
Mailing Address - Phone:208-354-3005
Mailing Address - Fax:208-354-3006
Practice Address - Street 1:215 E LITTLE AVE
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5137
Practice Address - Country:US
Practice Address - Phone:208-354-3005
Practice Address - Fax:208-354-3006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDDOOR REHABILITATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health