Organization
HOME LIVING SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TORI DANIEL SHAVER (OWNER)
(208) 232-9392
Entity
Organization
Contact information
Practice address
436 E BONNEVILLE ST, POCATELLO, ID 83201-6406
(208) 233-3466
(208) 234-9686
Mailing address
436 E BONNEVILLE ST, POCATELLO, ID 83201-6406
(208) 233-3466
(208) 234-9686
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
1319LS
ID
3336L0003X
Long Term Care Pharmacy
1319LS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002721800
—
ID
Enumeration date
09/22/2005
Last updated
08/10/2009
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