Clark Fork Healthcare, LLC
Organization Active NPI Home Health Agency · Eagle, ID
NPI 1457092058 · NPPES record last updated Apr 6, 2022
Key facts
- NPI
- 1457092058
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- CLARK FORK HEALTHCARE, LLC
- Practice address
- 1675 E Riverside Dr Ste 200
Eagle, ID 83616-7473 - Phone
- (208) 401-1400
- NPI assigned
- Apr 6, 2022
- Organization subpart
- No
Authorized official
- Name
- Lee Johnson
- Title
- Treasurer
- Phone
- (208) 401-1369
Corporate family (same tax ID) 3
National Provider Directory
- Tax ID family
- Big Sky Hospice
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
1675 E Riverside Dr Ste 200
Eagle, ID 83616-7473
Mailing address
1675 E Riverside Dr Ste 200
Eagle, ID 83616-7473
Phone (208) 401-1400
Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.