Organization
CLOUDNINE HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY BROOK KAY (OWNER)
(307) 248-8166
Entity
Organization
Contact information
Practice address
482 CONSTITUTION WAY STE 110, IDAHO FALLS, ID 83402-3568
(208) 552-0399
Mailing address
482 CONSTITUTION WAY STE 110, IDAHO FALLS, ID 83402-3568
(208) 552-0399
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A00003685
—
ID
05
—
A0003865
—
ID
Enumeration date
09/10/2019
Last updated
09/10/2019
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