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Organization
PROHEALTH
Active
Organization
PROHEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN WHEATLEY (OWNER)
(208) 241-1598
Entity
Organization
Contact information
Practice address
808 N 8TH AVE, POCATELLO, ID 83201-5718
(208) 241-1598
Mailing address
88 CEDAR HILLS DR, POCATELLO, ID 83204-4400
(208) 241-1598
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
NULL
311ZA0620X
Adult Care Home Facility
Primary
—
NULL
3747A0650X
Attendant Care Provider
—
NULL
3747A0650X
Attendant Care Provider
—
—
385H00000X
Respite Care
—
NULL
Other
Enumeration date
03/03/2021
Last updated
03/04/2021
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