Healthcare Provider Details

I. General information

NPI: 1295729283
Provider Name (Legal Business Name): MIDNIGHT OIL LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 LAWRENCE AVE
TWIN FALLS ID
83301-3635
US

IV. Provider business mailing address

498 FALLS AVE W
TWIN FALLS ID
83301-3689
US

V. Phone/Fax

Practice location:
  • Phone: 208-324-6776
  • Fax: 208-324-6636
Mailing address:
  • Phone: 208-324-6776
  • Fax: 208-324-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number5MVDEV037
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ROB BENNETT
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 208-324-6776