Provider Demographics
NPI:1093794703
Name:MAGIC VALLEY REHABILITATION SERVICES INC
Entity Type:Organization
Organization Name:MAGIC VALLEY REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CRUMRINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-734-4112
Mailing Address - Street 1:484 EASTLAND DRIVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7958
Mailing Address - Country:US
Mailing Address - Phone:208-734-4112
Mailing Address - Fax:208-734-1514
Practice Address - Street 1:484 EASTLAND DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7958
Practice Address - Country:US
Practice Address - Phone:208-734-4112
Practice Address - Fax:208-734-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5MVRS020251C00000X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered283Q00000XHospitalsPsychiatric Hospital