Provider Demographics
NPI:1659553196
Name:TREASURE VALLEY HOSPICE, LLC
Entity Type:Organization
Organization Name:TREASURE VALLEY HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-467-7423
Mailing Address - Street 1:8 6TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5095
Mailing Address - Country:US
Mailing Address - Phone:208-467-7423
Mailing Address - Fax:208-475-6038
Practice Address - Street 1:8 6TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5095
Practice Address - Country:US
Practice Address - Phone:208-467-7423
Practice Address - Fax:208-475-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808275400Medicaid
ID131558Medicare Oscar/Certification