Provider Demographics
NPI:1518185628
Name:MIDNIGHT OIL LTD
Entity Type:Organization
Organization Name:MIDNIGHT OIL LTD
Other - Org Name:MDC MAGIC VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-961-1469
Mailing Address - Street 1:498 FALLS AVE W
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3689
Mailing Address - Country:US
Mailing Address - Phone:208-961-1469
Mailing Address - Fax:
Practice Address - Street 1:798 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3635
Practice Address - Country:US
Practice Address - Phone:208-324-6776
Practice Address - Fax:208-324-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRHA-272251C00000X, 251S00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8066599Medicaid
ID807628200Medicaid