Provider Demographics
NPI:1417253873
Name:AUBURN CREST HOSPICE TREASURE VALLEY, LLC
Entity Type:Organization
Organization Name:AUBURN CREST HOSPICE TREASURE VALLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-376-7298
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-1176
Mailing Address - Country:US
Mailing Address - Phone:208-321-5073
Mailing Address - Fax:208-376-0269
Practice Address - Street 1:3751 N CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-3610
Practice Address - Country:US
Practice Address - Phone:208-321-5073
Practice Address - Fax:208-376-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based