Provider Demographics
NPI:1114129798
Name:PORTNEUF VALLEY FAMILY CENTER
Entity Type:Organization
Organization Name:PORTNEUF VALLEY FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-233-7832
Mailing Address - Street 1:PO BOX 4908
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4908
Mailing Address - Country:US
Mailing Address - Phone:208-233-7832
Mailing Address - Fax:
Practice Address - Street 1:2055 GARRETT WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5100
Practice Address - Country:US
Practice Address - Phone:208-233-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty