Organization
HEARTHSIDE HOSPICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB RAYMOND BRYAN MOT (OWNER)
(208) 419-0896
Entity
Organization
Contact information
Practice address
534 MAIN ST, SALMON, ID 83467-4219
(208) 419-0896
(208) 419-0974
Mailing address
403 1ST ST, IDAHO FALLS, ID 83401-3928
(208) 419-0896
(208) 419-0974
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Enumeration date
01/30/2014
Last updated
01/30/2014
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