Provider Demographics
NPI:1043209505
Name:PERSONAL CONNECTION HOME CARE
Entity type:Organization
Organization Name:PERSONAL CONNECTION HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-543-8222
Mailing Address - Street 1:629 11TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316-1505
Mailing Address - Country:US
Mailing Address - Phone:208-543-8222
Mailing Address - Fax:208-543-2725
Practice Address - Street 1:629 11TH AVE N
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-1505
Practice Address - Country:US
Practice Address - Phone:208-543-8222
Practice Address - Fax:208-543-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8057792Medicaid
ID0027118Medicaid