Provider Demographics
NPI:1407444268
Name:ASPEN VALLEY MT, LLC
Entity Type:Organization
Organization Name:ASPEN VALLEY MT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY & WELLNESS LEADER
Authorized Official - Prefix:
Authorized Official - First Name:CANDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-636-3460
Mailing Address - Street 1:360 E 10TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3273
Mailing Address - Country:US
Mailing Address - Phone:530-605-8841
Mailing Address - Fax:
Practice Address - Street 1:4455 E WARM SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-7214
Practice Address - Country:US
Practice Address - Phone:208-906-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility