S&G Hospice of Idaho LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

S&G HOSPICE OF IDAHO LLC

Practice address

1655 1St St
Idaho Falls, ID 83401-4305

Phone

(208) 552-0249

NPI assigned

Jul 28, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Brad Stauffer

Title

Owner/Managing Member

Phone

(208) 552-0249

Specialties & licenses 1

Addresses

Other names 1

• Alliance Hospice of Idaho Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Hospice certification: CCN 131544

Legal name

S&G HOSPICE OF IDAHO LLC

Doing business as

ALLIANCE HOSPICE OF IDAHO

Certification status

Active

Provider type (POS)

Hospice

Participating since

May 9, 2003

Last certification

Feb 17, 2022

Ownership / control type

Proprietary - Partnership

Organization structure

LLCProprietary

Incorporated

Oct 1, 2013 in ID

Enrollment address

1655 1St St
Idaho Falls, ID 83401-4305

Listed as

Alliance Hospice of IdahoCCN 131544

Ownership

For-Profit

Certified

May 9, 2003

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 8

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

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Alliance Home Health of Idaho, LLC

  • Community Based Hospice Care Agency
  • Twin Falls, ID
  • NPI 1467772897

  Acquired from, 2016-12-21

  CMS change of ownership

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Matthew J Fackrell, DO

  • Family Medicine Physician
  • Blackfoot, ID
  • NPI 1215968045

  Hospice

  Care Compare affiliation
• David Redford Liljenquist, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Idaho Falls, ID
  • NPI 1932109931

  Hospice

  Care Compare affiliation
• Andrew Thayne, M.D.

  • Family Medicine Physician
  • Pocatello, ID
  • NPI 1669405791

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1469664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1699228403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6255 E PARTRIDGE CIR",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834015925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 1ST ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014305",
            "telephone_number": "208-552-0249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S&G HOSPICE OF IDAHO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-28",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "STAUFFER",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "OWNER/MANAGING MEMBER",
        "authorized_official_telephone_number": "208-552-0249",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alliance Hospice of Idaho",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alliance Hospice of Idaho",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa J Russom, LSW
• Orin Kelley Ryan, DPT
• Rhonda Ryan, L.M.T.
• S. Albertson Dermatology and Skin Cancer Center LLC
• S&G Home Health LLC
• Katie K Sacco, LPC
• Angela J Sackett, D.C.
• Maryam Sadeghi
• Safe Harbor Counseling
• Safe Haven Counseling, LLC

• Community Based Hospice Care Agency in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Community Based Hospice Care Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.