Alliance Home Health of Idaho, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

ALLIANCE HOME HEALTH OF IDAHO, LLC

Practice address

353 N 4TH Ave
Suite 205
Pocatello, ID 83201-6390

Phone

(208) 478-2291

Fax

(208) 478-1363

NPI assigned

Nov 21, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Justin L. Larsen

Title

Owner, Ceo

Phone

(435) 753-3133

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063587509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 N 4TH AVE",
            "address_2": "SUITE 205",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016390",
            "telephone_number": "208-478-2291",
            "fax_number": "208-478-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 N 4TH AVE",
            "address_2": "SUITE 205",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016390",
            "telephone_number": "208-478-2291",
            "fax_number": "208-478-1363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE HOME HEALTH OF IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER, CEO",
        "authorized_official_telephone_number": "435-753-3133",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.