Great Western Distribution of Idaho, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

GREAT WESTERN DISTRIBUTION OF IDAHO, LLC

Doing business as

Custom Home Solutions

Practice address

480 E Franklin Rd
Suite 108
Meridian, ID 83642-2919

Phone

(208) 888-7561

Fax

(208) 287-3695

NPI assigned

Nov 18, 2011

Last updated

Nov 18, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sherman Leibow

Title

Owner

Phone

(208) 342-4800

Specialties & licenses 1

Addresses

Other names 1

• Custom Home Solutions Doing business as

Locations

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

{
    "created_epoch": "1321574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321574400000",
    "number": "1497022420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 E FRANKLIN RD",
            "address_2": "SUITE 108",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422919",
            "telephone_number": "208-888-7561",
            "fax_number": "208-287-3695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 E FRANKLIN RD",
            "address_2": "SUITE 108",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422919",
            "telephone_number": "208-888-7561",
            "fax_number": "208-287-3695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT WESTERN DISTRIBUTION OF IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-18",
        "last_updated": "2011-11-18",
        "status": "A",
        "authorized_official_last_name": "LEIBOW",
        "authorized_official_first_name": "SHERMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-342-4800"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Home Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Meridian, ID
• Providers in Meridian, ID by specialty
• Durable Medical Equipment & Medical Supplies in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.