Provider Demographics
NPI:1639307358
Name:CHAROLAIS CARE VIII, INC
Entity Type:Organization
Organization Name:CHAROLAIS CARE VIII, INC
Other - Org Name:MOUNTAIN VIEW CENTER FOR GERIATRIC PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-221-2019
Mailing Address - Street 1:2043 E CENTER ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3300
Mailing Address - Country:US
Mailing Address - Phone:208-233-4673
Mailing Address - Fax:208-233-4750
Practice Address - Street 1:500 POLK ST E
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-1618
Practice Address - Country:US
Practice Address - Phone:208-423-5591
Practice Address - Fax:208-423-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
134014Medicare Oscar/Certification