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General NPI Number Information
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NPI Number | 1407444268
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Entity Type | Organization
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Legal Business Name | ASPEN VALLEY MT, LLC
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 4455 E WARM SPRINGS AVE
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City | BOISE
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State | ID
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Zip | 83716-7214
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Country | US
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Telephone | 208-906-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 360 E 10TH AVE STE 104
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City | EUGENE
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State | OR
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Zip | 97401-3273
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Country | US
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Telephone | 530-605-8841
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Fax |
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Authorized Official
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Title or Position | QUALITY & WELLNESS LEADER
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Name | CANDIS WILLIS
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Credential |
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Telephone | 541-636-3460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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