NPIMap

Organization Active NPI

Crest Home Health and Hospice, LLC

  • Community Based Hospice Care Agency
  • Coeur D Alene, ID
National Provider Identifier
1346504784
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
CREST HOME HEALTH AND HOSPICE, LLC
Practice address
700 W Ironwood Dr
Suite 300
Coeur D Alene, ID 83814-2656
Phone
(208) 765-4343
Fax
(208) 667-0494
NPI assigned
Jun 29, 2012
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) 397-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X ID Primary

Addresses

Primary practice location

700 W Ironwood Dr
Suite 300
Coeur D Alene, ID 83814-2656

Mailing address

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

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
O20120807000380 ID Part A Provider - Hospice 3072769058 Practice locations: Coeur D Alene, ID

Hospice certification: CCN 131557

Legal name
CREST HOME HEALTH AND HOSPICE, LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 27, 2007
Last certification
Dec 2, 2021
Ownership / control type
Other
Organization structure
LLCNon-profit
Incorporated
Jun 11, 2012 in UT
Enrollment address
2100 Northwest Blvd
Ste 120
Coeur D Alene, ID 83814-5047

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: Hospice

Medicare Care Compare
Listed as
Crest Home Health and Hospice, LLCCCN 131557
Ownership
Non-Profit
Certified
Aug 27, 2007
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Crest Home Health and Hospice4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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 300
Coeur D Alene, ID 83814
Phone (208) 765-2273

Ownership & related parties

All disclosed owners & managing parties 12

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 16.66%
Raymond N Beeman Individual Corporate OfficerVali Division Wasatch BRD Secretary Sep 22, 2022 16.66%
Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022
Edward L Bangerter Individual Operational/Managerial ControlRMC LLC Chain Home Office President Apr 7, 2020
Laura Boardman Individual Corporate OfficerVali Division Wasatch BRD Treasurer Sep 22, 2022 16.66%
Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022
Rocky Mountain Care LLC Organization, Murray, UT LLC, For-profit Operational/Managerial Control Apr 7, 2020
Vali Division of Wasatch, Inc Organization, Murray, UT Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2016 100%
Kelly Milbrath Individual W-2 Managing EmployeeAd; May 15, 2024 100%
Bradley Mikesell Individual Corporate OfficerVali Division Wasatch BRD President Sep 22, 2022 16.66%
Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022
Alan Kris Widdison Individual Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022 16.66%
Michael G Meza Individual Contracted Managing EmployeeMD; Mar 1, 2024
Lance D Samuelson Individual Corporate DirectorVali Division Wasatch BRD Member Sep 22, 2022 16.66%
Crest, LLC Organization, Murray, UT Created for acquisition, LLC, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2016 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1340928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642464000000",
    "number": "1346504784",
    "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": "SUITE 300",
            "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": "2012-06-29",
        "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": "801-397-4000"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DSM@rockymountaincare.brightreedirect.net",
            "affiliation": "N",
            "endpointDescription": "Direct Secure Messaging Inbox",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "700 W Ironwood Dr",
            "address_2": "Suite 300",
            "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.