Organization
MINI-CASSIA HEARTS 4 SENIORS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLI ROWE (ADMINISTRATOR)
(208) 312-5715
Entity
Organization
Contact information
Practice address
135 EAST 23RD DRIVE, BURLEY, ID 83318
(208) 312-5715
Mailing address
2450 OVERLAND AVE, BURLEY, ID 83318-2933
(208) 878-5715
(208) 878-5716
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0003627
—
ID
Enumeration date
02/11/2019
Last updated
08/10/2022
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