Provider Demographics
NPI:1518170968
Name:PORTNEUF VALLEY FAMILY CENTER
Entity Type:Organization
Organization Name:PORTNEUF VALLEY FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-233-7832
Mailing Address - Street 1:PO BOX 4908
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4908
Mailing Address - Country:US
Mailing Address - Phone:208-233-7832
Mailing Address - Fax:
Practice Address - Street 1:725 JENSEN GROVE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1636
Practice Address - Country:US
Practice Address - Phone:208-233-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty