# MOMBA HOME CARE IDAHO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346078656
- **Authorized official:** ELAZAR HUISMAN (NPI MANAGER)
- **Authorized official phone:** (404) 418-7484

## Contact information

- **Practice address:** 950 W BANNOCK ST STE 1100, BOISE, ID 83702-6140
- **Practice address phone:** (800) 553-3495
- **Mailing address:** 400 PERIMETER CENTER TER NE STE 300, ATLANTA, GA 30346-1201
- **Mailing address phone:** (800) 553-3495

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 07/26/2024
- **Last updated:** 04/21/2026