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General NPI Number Information
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NPI Number | 1093018939
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Entity Type | Organization
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Legal Business Name | TREASURE VALLEY BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 131 N WHITLEY DR
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City | FRUITLAND
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State | ID
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Zip | 83619-2430
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Country | US
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Telephone | 208-452-7705
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Fax | 208-452-7750
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Provider Business Mailing Address
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Address Line | PO BOX 1022
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City | FRUITLAND
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State | ID
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Zip | 83619-1022
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Country | US
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Telephone |
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Fax | 208-452-7750
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Authorized Official
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Title or Position | OWNER
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Name | BRADI C FRITTS
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Credential | LMSW
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Telephone | 208-452-7705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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