NPIMap

Organization Active NPI

Crest Home Health and Hospice, LLC

  • Home Health Agency
  • Coeur d'Alene, ID
National Provider Identifier
1194722405
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
HH124 Issued in ID
Legal business name
CREST HOME HEALTH AND HOSPICE, LLC
Practice address
700 W Ironwood Dr
Ste 255
Coeur D Alene, ID 83814-2656
Phone
(208) 765-4343
Fax
(208) 667-0494
NPI assigned
Jun 30, 2005
Last updated
Jan 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2022

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

Authorized official

Name
Troy K Thompson
Title
Board President
Phone
(801) 397-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HH124 ID Primary

Addresses

Primary practice location

700 W Ironwood Dr
Ste 255
Coeur D Alene, ID 83814-2656

Mailing address

598 W 900 S Ste 220
Woods Cross, UT 84010-8195
Phone (801) 397-4697

Other identifiers 1

IdentifierTypeStateIssuer
002737100MedicaidID

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address DSM@rockymountaincare.brightreedirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160204000032 ID Part A Provider - Home Health Agency 3072769058 Practice locations: Coeur D Alene, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194722405. Details of each certification follow.

Home health agency certification: CCN 137070

Legal name
CREST HOME HEALTH AND HOSPICE, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 17, 1994
Last certification
Feb 25, 2021
Ownership / control type
Non-Profit
Organization structure
LLCNon-profit
Incorporated
Jun 11, 2012 in UT
Enrollment address
2100 Northwest Blvd
Ste 120
Coeur D Alene, ID 83814-5047
HHA Branch

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Crest Home Health & Hospice, LLCCCN 137070 · All quality measures
Overall star rating
2.5 of 5
Ownership
Non-Profit
Certified
Mar 17, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Crest Home Health and Hospice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

700 W Ironwood Dr
Ste 255
Coeur D Alene, ID 83814
Phone (208) 765-4343

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Fredrick Hale Individual Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022
Raymond N Beeman Individual Corporate OfficerVali Division Wasatch BRD Secretary Sep 22, 2022
Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022
Edward L Bangerter Individual Operational/Managerial ControlRMC LLC Chain HM Office President Apr 7, 2020
Laura Boardman Individual Corporate OfficerVali Division Wasatch BRD Treasurer Sep 22, 2022
Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022
Rocky Mountain Care LLC Organization, Murray, UT LLC, For-profit, Chain home office Operational/Managerial Control Apr 7, 2020 100%
Vali Division of Wasatch, Inc Organization, Murray, UT Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Apr 7, 2020 100%
Bradley Mikesell Individual Corporate OfficerVali Division Wasatch BRD President Sep 22, 2022
Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022
Alan Kris Widdison Individual Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022
Nathan Ziegler Individual W-2 Managing EmployeeAdministrator May 1, 2023
Lance D Samuelson Individual Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022
Crest, LLC Organization, Murray, UT LLC, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Apr 7, 2020 100%

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 12

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642464000000",
    "number": "1194722405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "598 W 900 S STE 220",
            "city": "WOODS CROSS",
            "state": "UT",
            "postal_code": "840108195",
            "telephone_number": "801-397-4697",
            "fax_number": "801-296-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR",
            "address_2": "STE 255",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142656",
            "telephone_number": "208-765-4343",
            "fax_number": "208-667-0494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREST HOME HEALTH AND HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "TROY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "BOARD PRESIDENT",
        "authorized_official_telephone_number": "801-397-4100"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ID",
            "license": "HH124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002737100",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DSM@rockymountaincare.brightreedirect.net",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "700 W Ironwood Dr",
            "address_2": "Ste 255",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838142656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.