Provider Demographics
NPI:1336216621
Name:VALLEY VISTA CARE CORPORATION
Entity Type:Organization
Organization Name:VALLEY VISTA CARE CORPORATION
Other - Org Name:VISTA OUTREACH - MENTAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-245-4576
Mailing Address - Street 1:820 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-2119
Mailing Address - Country:US
Mailing Address - Phone:208-245-4576
Mailing Address - Fax:208-245-2138
Practice Address - Street 1:127 S 7TH ST
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1801
Practice Address - Country:US
Practice Address - Phone:208-245-1920
Practice Address - Fax:208-245-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)