Healthcare Provider Details

I. General information

NPI: 1518267897
Provider Name (Legal Business Name): OATS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S HIGHWAY 30
HEYBURN ID
83336-5001
US

IV. Provider business mailing address

911 S HIGHWAY 30
HEYBURN ID
83336-5001
US

V. Phone/Fax

Practice location:
  • Phone: 208-679-2273
  • Fax: 208-679-3368
Mailing address:
  • Phone: 208-679-2273
  • Fax: 208-679-3368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number17053195340039
License Number StateID

VIII. Authorized Official

Name: SALLY HALL
Title or Position: PRESIDENT
Credential:
Phone: 208-670-3116