Provider Demographics
NPI:1487829925
Name:SCOTT COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:SCOTT COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-877-1999
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:DEARY
Mailing Address - State:ID
Mailing Address - Zip Code:83823-0307
Mailing Address - Country:US
Mailing Address - Phone:208-877-1999
Mailing Address - Fax:208-877-9004
Practice Address - Street 1:507 OREGON ST.
Practice Address - Street 2:
Practice Address - City:DEARY
Practice Address - State:ID
Practice Address - Zip Code:83823
Practice Address - Country:US
Practice Address - Phone:208-877-1999
Practice Address - Fax:208-877-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8074673OtherMEDICAID