Organization
RJN BOISE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL JEROME NILSON (MEMBER/MANAGER)
(208) 409-8798
Entity
Organization
Contact information
Practice address
2000 S PEPPERCORN PL, BOISE, ID 83709-2249
(208) 409-8798
Mailing address
2000 S PEPPERCORN PL, BOISE, ID 83709-2249
(208) 409-8798
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4295493
—
ID
Enumeration date
06/12/2021
Last updated
06/12/2021
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