Organization
LHCG XVII, LLC
Active
Other names
Idaho Home Care Supply
Organization subpart
No
Provider details
NPI number
Authorized official
PETER C NOVEMBER II (EXECUTIVE VICE PRESIDENT)
(337) 233-1307
Entity
Organization
Contact information
Practice address
418 ONEIDA ST, RUPERT, ID 83350-1748
(208) 436-5855
(208) 436-5310
Mailing address
PO BOX 51266, LAFAYETTE, LA 70505-1266
(337) 233-1307
(337) 233-5764
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/22/2010
Last updated
06/22/2010
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