Healthcare Provider Details

I. General information

NPI: 1528089356
Provider Name (Legal Business Name): VALLEY FAMILY HEATLH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NE 10TH AVE
PAYETTE ID
83661-5422
US

IV. Provider business mailing address

1441 NE 10TH AVE
PAYETTE ID
83661-5420
US

V. Phone/Fax

Practice location:
  • Phone: 208-642-9379
  • Fax: 208-642-5004
Mailing address:
  • Phone: 208-643-9376
  • Fax: 208-642-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KENNETH ROBERT HART
Title or Position: CEO
Credential:
Phone: 208-642-7364