NPIMap

Organization Active NPI

State of Idaho

  • Community Based Hospice Care Agency
  • Pocatello, ID
National Provider Identifier
1902995814
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
13-1512 Issued in ID
Legal business name
STATE OF IDAHO
Practice address
1901 Alvin Ricken Dr
Pocatello, ID 83201-2727
Phone
(208) 239-5240
Fax
(208) 478-6306
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Edward A. Marugg, R.E.H.S.
Title
District Director
Phone
(208) 233-9080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 13-1512 ID Primary

Addresses

Primary practice location

1901 Alvin Ricken Dr
Pocatello, ID 83201-2727

Mailing address

1901 Alvin Ricken Dr
Pocatello, ID 83201-2727
Phone (208) 239-5240

Other names 1

  • Southeastern District Health Department Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902995814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 ALVIN RICKEN DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012727",
            "telephone_number": "208-239-5240",
            "fax_number": "208-478-6306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 ALVIN RICKEN DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012727",
            "telephone_number": "208-239-5240",
            "fax_number": "208-478-6306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARUGG",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "DISTRICT DIRECTOR",
        "authorized_official_telephone_number": "208-233-9080",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.E.H.S."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "ID",
            "license": "13-1512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern District Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.