Mary Clarice Callister
Individual provider Active NPI Home Health Agency · Boise, ID
NPI 1780301671 · NPPES record last updated Oct 21, 2022
Key facts
- NPI
- 1780301671
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Agency 251E00000X
- Practice address
- 5670 N Kercliffe CT
Boise, ID 83704-2050 - Phone
- (208) 608-8114
- NPI assigned
- Oct 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
5670 N Kercliffe CT
Boise, ID 83704-2050
Mailing address
5670 N Kercliffe CT
Boise, ID 83704-2050
Phone (208) 608-8114
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 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.