Healthcare Provider Details

I. General information

NPI: 1518185628
Provider Name (Legal Business Name): MIDNIGHT OIL LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/16/2014
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: 208-961-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberRHA-272
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberRHA-272
License Number StateID

VIII. Authorized Official

Name: ROB BENNETT
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 208-961-1469