Provider Demographics
NPI:1114534112
Name:CANYON STEPS, LLC
Entity Type:Organization
Organization Name:CANYON STEPS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, QIDP
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MS
Authorized Official - Phone:208-358-2982
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:SWAN VALLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83449-0143
Mailing Address - Country:US
Mailing Address - Phone:208-358-2982
Mailing Address - Fax:208-483-2174
Practice Address - Street 1:3325 US HWY 26
Practice Address - Street 2:
Practice Address - City:SWAN VALLEY
Practice Address - State:ID
Practice Address - Zip Code:83449
Practice Address - Country:US
Practice Address - Phone:208-358-2982
Practice Address - Fax:208-483-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management