Healthcare Provider Details

I. General information

NPI: 1780751966
Provider Name (Legal Business Name): VALLEY VISTA CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 BEVERLAND ROAD
MACKAY ID
83251-0239
US

IV. Provider business mailing address

820 ELM ST
ST MARIES ID
83861-2119
US

V. Phone/Fax

Practice location:
  • Phone: 208-588-2600
  • Fax: 208-588-3104
Mailing address:
  • Phone: 208-245-4576
  • Fax: 208-245-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: GAIL MILLS
Title or Position: CORPORATE COMPLIANCE MANAGER
Credential:
Phone: 208-245-4576