13D0878627 CLIA NUMBER - LHCG XVII LLC DBA IDAHO HOME HEALTH & HOSPICE

Laboratory Demographics

CLIA Number: 13D0878627

Facility Name: LHCG XVII LLC DBA IDAHO HOME HEALTH & HOSPICE

Facility Address:
722 N COLLEGE RD STE 150
TWIN FALLS, ID
ZIP 83301
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Facility Phone Number: 208 734-4061

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1356669675

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	13D0878627
LAB Type	Hospice
Facility Name	LHCG XVII LLC DBA IDAHO HOME HEALTH & HOSPICE
Street	722 N COLLEGE RD STE 150
City	TWIN FALLS
State	ID
ZIP	83301
Phone	208 734-4061
CertificateType	4
CertificateEffectiveDate	10/29/2023
CertificateExpirationDate	10/28/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024