NPIMap

Organization Active NPI

Canyon Idaho Home Care & Hospice, LLC

Doing business as Canyon Home Care & Hospice

  • Community Based Hospice Care Agency
  • Fruitland, ID
National Provider Identifier
1386188191
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
CANYON IDAHO HOME CARE & HOSPICE, LLC
Doing business as
Canyon Home Care & Hospice
Practice address
929 NW 16TH St
Fruitland, ID 83619-2256
Phone
(208) 642-1838
Fax
(888) 572-2145
NPI assigned
Dec 13, 2016
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Kenneth E Norris
Title
Managing Partner
Phone
(801) 485-6166

Specialties & licenses 1

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

Addresses

Primary practice location

929 NW 16TH St
Fruitland, ID 83619-2256

Mailing address

450 S 900 E
Ste. 100
Salt Lake City, UT 84102-2981
Phone (801) 485-6166

Other names 1

  • Canyon Home Care & Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170131001596 ID Part A Provider - Hospice 9830470442 Practice locations: Meridian, ID; Fruitland, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386188191. Details of each certification follow.

Hospice certification: CCN 131577

Legal name
CANYON IDAHO HOME CARE & HOSPICE LLC
Doing business as
CANYON HOME CARE & HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 20, 2017
Last certification
Jun 20, 2017
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Nov 29, 2016 in ID
Enrollment address
929 NW 16TH St
Fruitland, ID 83619-2256

Care Compare: Hospice

Medicare Care Compare
Listed as
Canyon Home Care & HospiceCCN 131577 · All quality measures
Ownership
For-Profit
Certified
Jun 20, 2017
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Canyon Idaho Home Care Hospice LLC2 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.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Orange Healthcare, LLC Organization, Holladay, UT LLC 5% Or Greater Indirect Ownership Interest Jan 20, 2017 50%
Kenneth Edwin Norris Individual 5% Or Greater Indirect Ownership Interest Jan 20, 2017 50%
Operational/Managerial Control Jan 20, 2017
Tyson Cichos Individual 5% Or Greater Indirect Ownership Interest Jan 20, 2017 25%
Cory R Robison Individual 5% Or Greater Indirect Ownership Interest Jan 20, 2017 25%
Home Caregivers Partnership, LLC Organization, Salt Lake City, UT LLC 5% Or Greater Direct Ownership Interest Jan 20, 2017 100%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Canyon Home Care & HospiceFruitland, ID, CCN 137068 Home health agency 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 9

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": "1481587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1386188191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 S 900 E",
            "address_2": "STE. 100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841022981",
            "telephone_number": "801-485-6166",
            "fax_number": "801-531-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 NW 16TH ST",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192256",
            "telephone_number": "208-642-1838",
            "fax_number": "888-572-2145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON IDAHO HOME CARE & HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-13",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "NORRIS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "801-485-6166"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Home Care & Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fruitland, ID

Sources for this page

Verify at the official NPI Registry.