13D1051490 CLIA NUMBER - EH HOSPICE OF THE WEST LLC DBA ENHABIT HOSPICE OF EASTERN IDAHO

Laboratory Demographics

CLIA Number: 13D1051490

Facility Name: EH HOSPICE OF THE WEST LLC DBA ENHABIT HOSPICE OF EASTERN IDAHO

Facility Address:
183 VISTA DR STE B
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 637-1100

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1326329780

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	13D1051490
LAB Type	Hospice
Facility Name	EH HOSPICE OF THE WEST LLC DBA ENHABIT HOSPICE OF EASTERN IDAHO
Street	183 VISTA DR STE B
City	POCATELLO
State	ID
ZIP	83201
Phone	208 637-1100
CertificateType	4
CertificateEffectiveDate	3/3/2024
CertificateExpirationDate	3/2/2026
FacilityType	Waiver

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