Healthcare Provider Details

I. General information

NPI: 1730365867
Provider Name (Legal Business Name): MOUNTAIN VALLEY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 YELLOWSTONE AVE
POCATELLO ID
83201-4530
US

IV. Provider business mailing address

342 YELLOWSTONE AVE
POCATELLO ID
83201-4530
US

V. Phone/Fax

Practice location:
  • Phone: 208-479-1996
  • Fax: 801-880-4448
Mailing address:
  • Phone: 208-479-1996
  • Fax: 801-880-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT N PERKINS
Title or Position: CEO
Credential:
Phone: 801-725-0252