Healthcare Provider Details

I. General information

NPI: 1679404743
Provider Name (Legal Business Name): WEST VALLEY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 S INDIANA AVE
CALDWELL ID
83605-6457
US

IV. Provider business mailing address

3720 S INDIANA AVE
CALDWELL ID
83605-6457
US

V. Phone/Fax

Practice location:
  • Phone: 208-453-4333
  • Fax:
Mailing address:
  • Phone: 208-453-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JARED RUCKS
Title or Position: CFO
Credential:
Phone: 208-455-3720