Healthcare Provider Details

I. General information

NPI: 1336762566
Provider Name (Legal Business Name): TREASURE VALLEY HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S RACKHAM WAY
MERIDIAN ID
83642-1092
US

IV. Provider business mailing address

5108 N MAIDSTONE WAY
BOISE ID
83713-1367
US

V. Phone/Fax

Practice location:
  • Phone: 208-577-8672
  • Fax: 208-209-6058
Mailing address:
  • Phone: 208-577-8672
  • Fax: 208-939-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CANDICE ELAINE ADAMS
Title or Position: CEO
Credential: DNP
Phone: 208-577-8672