Organization
HOME AND AWAY MEDICAL TRANSPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM CHARLES HATHAWAY (OWNER)
(208) 704-0153
Entity
Organization
Contact information
Practice address
1421 W POLELINE AVE, POST FALLS, ID 83854-9828
(208) 704-0153
Mailing address
1421 W POLELINE AVE, POST FALLS, ID 83854-9828
(208) 704-0153
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
06/21/2016
Last updated
06/21/2016
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