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General NPI Number Information
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NPI Number | 1295879542
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Entity Type | Organization
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Legal Business Name | HIGH VALLEY DEVELOPMENTAL
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4806 SOUTHSIDE BLVD
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City | NAMPA
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State | ID
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Zip | 83686-8919
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Country | US
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Telephone | 208-466-4286
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Fax | 208-442-1345
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Provider Business Mailing Address
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Address Line | 4806 SOUTHSIDE BLVD
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City | NAMPA
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State | ID
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Zip | 83686-8919
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Country | US
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Telephone |
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Fax | 208-442-1345
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Authorized Official
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Title or Position | OWNER
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Name | BRAD JENSEN
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Credential |
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Telephone | 208-861-8360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 8065566500
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License Number State | ID
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