MEDICARE: 1 ASSIST CARE OF TREASURE VALLEY WEST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1659849883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1 ASSIST CARE OF TREASURE VALLEY WEST LLC

Provider Business Mailing Address
First Line	:	3965 W 2000 S
Second Line	:
City	:	REXBURG
State	:	ID
Zip	:	83440-4012
Country	:	US
Telephone Number	:	208-557-4215
Fax Number	:	888-384-0874

Provider Business Practice Location Address
First Line	:	418 S 9TH AVE
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-4153
Country	:	US
Telephone Number	:	208-214-3008
Fax Number	:	888-384-0874

Authorized Official
Title or Position	:	MANAGER/MEMBER
Name	:	ANDREW RAIL
Credential	:	MPP
Telephone Number	:	208-557-4215

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	11/06/2018

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