Canyon Idaho Home Care & Hospice, LLC
Organization Active NPI Community Based Hospice Care Agency · Fruitland, ID
NPI 1386188191 · NPPES record last updated Oct 29, 2024
Key facts
- NPI
- 1386188191
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- CANYON IDAHO HOME CARE & HOSPICE, LLC
- Practice address
- 929 NW 16TH St
Fruitland, ID 83619-2256 - Phone
- (208) 642-1838
- Fax
- (888) 572-2145
- NPI assigned
- Dec 13, 2016
- Organization subpart
- No
Authorized official
- Name
- Kenneth E Norris
- Title
- Managing Partner
- Phone
- (801) 485-6166
Owners & managing parties with NPI records 2
Owned or controlled facilities with NPI records 1
Corporate family (same tax ID) 1
Member of 1
Member organizations 2
Facilities with the same owner 9
Affiliated clinicians 2
-
Jordan V Blanchard, M.D.
Medicare Care Compare: Hospice
- Listed as
- Canyon Home Care & Hospice
- Ownership
- For-Profit
- Certified
- Jun 20, 2017
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
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
- LLC · Proprietary
- Incorporated
- Nov 29, 2016 in ID
- Enrollment address
- 929 NW 16TH St
Fruitland, ID 83619-2256
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Orange Healthcare, LLC |
5% Or Greater Indirect Ownership Interest | Jan 20, 2017 | 50% |
| Kenneth Edwin Norris |
5% Or Greater Indirect Ownership Interest | Jan 20, 2017 | 50% |
| Operational/Managerial Control | Jan 20, 2017 | ||
| Tyson Cichos |
5% Or Greater Indirect Ownership Interest | Jan 20, 2017 | 25% |
| Cory R Robison |
5% Or Greater Indirect Ownership Interest | Jan 20, 2017 | 25% |
| Home Caregivers Partnership, LLC |
5% Or Greater Direct Ownership Interest | Jan 20, 2017 | 100% |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Canyon Home Care & Hospice |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170131001596 | ID | Part a Provider - Hospice | 9830470442 | Practice locations: Meridian, ID; Fruitland, ID |
National Provider Directory
- Tax ID family
- Canyon Idaho Home Care Hospice LLC
Locations
929 NW 16th St
Fruitland, ID 83619
Phone (208) 642-1838
2440 S Titanium Pl
Meridian, ID 83642
Phone (208) 453-2659
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
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
- Canyon Home Care & Hospice
Other providers in Fruitland, ID
- Paige Bunker
- Emily Burnett
- Terry A. Buster
- Nani Jane Cabrera
- Columbus Candies
- Care at Home, Inc.
- Care Continuum, Inc.
- Cej Supply LLC
- Childrens Dentistry of Fruitland
- David M. Christensen
All providers in Fruitland, ID · Community Based Hospice Care Agency in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.