Provider Demographics
NPI:1497761050
Name:VALLEY VISTA CARE CORPORATION
Entity Type:Organization
Organization Name:VALLEY VISTA CARE CORPORATION
Other - Org Name:VALLEY VISTA OF SANDPOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE COMPLIANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-245-4576
Mailing Address - Street 1:820 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-2119
Mailing Address - Country:US
Mailing Address - Phone:208-245-4576
Mailing Address - Fax:208-245-2138
Practice Address - Street 1:220 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1759
Practice Address - Country:US
Practice Address - Phone:208-265-4514
Practice Address - Fax:208-263-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID10314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID135055Medicare ID - Type UnspecifiedPROVIDER NUMBER