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Individual

MONTE CACHE HIBBERT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
121 N 18TH AVE, POCATELLO, ID 83201-3345
(208) 234-7383
Mailing address
121 N 18TH AVE, POCATELLO, ID 83201-3345
(208) 234-7383

Taxonomy

Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
CFH-4005-SD
ID

Other

Enumeration date
07/06/2016
Last updated
07/06/2016
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