Provider Demographics
NPI:1871055152
Name:3 AND 1, LLC
Entity type:Organization
Organization Name:3 AND 1, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZASTROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-758-8090
Mailing Address - Street 1:1900 NORTHWEST BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2788
Mailing Address - Country:US
Mailing Address - Phone:208-758-8090
Mailing Address - Fax:208-214-3222
Practice Address - Street 1:1900 NORTHWEST BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2788
Practice Address - Country:US
Practice Address - Phone:208-758-8090
Practice Address - Fax:208-214-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care