# A FULL LIFE AGENCY

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

## Provider details

- **NPI number:** 1346327194
- **Authorized official:** MR. DONALD D GROSS (PRESIDENT)
- **Authorized official phone:** (208) 762-5433

## Contact information

- **Practice address:** 9075 N GOVERNMENT WAY, HAYDEN, ID 83835-9217
- **Practice address phone:** (208) 762-9835
- **Practice address fax:** (208) 762-0935
- **Mailing address:** 9297 N GOVERNMENT WAY STE C, HAYDEN, ID 83835-9290
- **Mailing address phone:** (208) 762-5433
- **Mailing address fax:** (208) 209-0007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 08/22/2020