Provider Demographics
NPI:1659849883
Name:1 ASSIST CARE OF TREASURE VALLEY WEST LLC
Entity Type:Organization
Organization Name:1 ASSIST CARE OF TREASURE VALLEY WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MPP
Authorized Official - Phone:208-557-4215
Mailing Address - Street 1:3965 W 2000 S
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-4012
Mailing Address - Country:US
Mailing Address - Phone:208-557-4215
Mailing Address - Fax:888-384-0874
Practice Address - Street 1:418 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4153
Practice Address - Country:US
Practice Address - Phone:208-214-3008
Practice Address - Fax:888-384-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care