| Organization Name: | HEARTHSIDE HOSPICE, LLC |
| NPI Number: | 1740603505 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACOB RAYMOND BRYAN (OWNER) |
| Mailing Address: | 534 Main St Salmon |
| State: | ID US |
| Postal Code: | 834674219 |
| Phone Number: | 2084190896 |
| Fax Number: | 2084190974 |
| NPI Enumeration Date: | 01/30/2014 |
| NPI Last Update Date: | 01/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |