Organization
ST LUKES MEDICAL CENTER WOODRIVER LTD
Active
Other names
SLWR HOSPICE HOMECARE
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE JENSEN (DIRECTOR)
(208) 788-2222
Entity
Organization
Contact information
Practice address
100 HOSPITAL DRIVE, KETCHUM, ID 83340
(208) 788-2222
Mailing address
PO BOX 1098, BOISE, ID 83701-1098
(208) 381-2333
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
62
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62
STATE LIC #
ID
Enumeration date
03/05/2007
Last updated
12/05/2007
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