Healthcare Provider Details

I. General information

NPI: 1487093845
Provider Name (Legal Business Name): UPPER VALLEY RESOURCE & COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S RAILROAD AVE
SUGAR CITY ID
83448-5072
US

IV. Provider business mailing address

1223 S RAILROAD AVE
SUGAR CITY ID
83448-5072
US

V. Phone/Fax

Practice location:
  • Phone: 208-359-0519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL K HYMAS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 208-359-0519