Provider Demographics
NPI:1578524575
Name:VALLEY HOME OXYGEN
Entity Type:Organization
Organization Name:VALLEY HOME OXYGEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:208-847-1700
Mailing Address - Street 1:762 1/2 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-1422
Mailing Address - Country:US
Mailing Address - Phone:208-847-1700
Mailing Address - Fax:208-847-1578
Practice Address - Street 1:762 1/2 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-1422
Practice Address - Country:US
Practice Address - Phone:208-847-1700
Practice Address - Fax:208-847-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDME126332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002719500Medicaid
ID0516070001Medicare ID - Type UnspecifiedMEDICARE NUMBER