Healthcare Provider Details

I. General information

NPI: 1740065309
Provider Name (Legal Business Name): TREASURE VALLEY ROSSITER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 S TYRELL LN
BOISE ID
83706-4060
US

IV. Provider business mailing address

667 W SEDGEWICK ST
MERIDIAN ID
83646-8333
US

V. Phone/Fax

Practice location:
  • Phone: 208-949-3868
  • Fax:
Mailing address:
  • Phone: 208-954-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELLEN NICOLE ARGO
Title or Position: OWNER
Credential: ROSSITER
Phone: 208-954-4212