Organization
A FULL LIFE AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD D GROSS (PRESIDENT)
(208) 762-5433
Entity
Organization
Contact information
Practice address
9075 N GOVERNMENT WAY, HAYDEN, ID 83835-9217
(208) 762-9835
(208) 762-0935
Mailing address
9297 N GOVERNMENT WAY STE C, HAYDEN, ID 83835-9290
(208) 762-5433
(208) 209-0007
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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