Provider Demographics
NPI:1649704248
Name:MVH PMHS LLC
Entity type:Organization
Organization Name:MVH PMHS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NED
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLYARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-709-4571
Mailing Address - Street 1:475 YELLOWSTONE AVE
Mailing Address - Street 2:STE E
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4528
Mailing Address - Country:US
Mailing Address - Phone:208-232-0021
Mailing Address - Fax:
Practice Address - Street 1:475 YELLOWSTONE AVE
Practice Address - Street 2:STE E
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4528
Practice Address - Country:US
Practice Address - Phone:208-232-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty