Organization
GREAT WESTERN DISTRIBUTION OF IDAHO, LLC
Active
Other names
Custom Home Solutions
Organization subpart
No
Provider details
NPI number
Authorized official
SHERMAN LEIBOW (OWNER)
(208) 342-4800
Entity
Organization
Contact information
Practice address
480 E FRANKLIN RD, SUITE 108, MERIDIAN, ID 83642-2919
(208) 888-7561
(208) 287-3695
Mailing address
480 E FRANKLIN RD, SUITE 108, MERIDIAN, ID 83642-2919
(208) 888-7561
(208) 287-3695
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
11/18/2011
Last updated
11/18/2011
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