Provider Demographics
NPI:1740065309
Name:TREASURE VALLEY ROSSITER, LLC
Entity type:Organization
Organization Name:TREASURE VALLEY ROSSITER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ARGO
Authorized Official - Suffix:
Authorized Official - Credentials:ROSSITER
Authorized Official - Phone:208-954-4212
Mailing Address - Street 1:667 W SEDGEWICK ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-8333
Mailing Address - Country:US
Mailing Address - Phone:208-954-4212
Mailing Address - Fax:
Practice Address - Street 1:1509 S TYRELL LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-4060
Practice Address - Country:US
Practice Address - Phone:208-949-3868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery CareGroup - Single Specialty