Provider Demographics
NPI:1952612756
Name:LOST RIVER AREA TRANSIT - COMMERCIAL
Entity Type:Organization
Organization Name:LOST RIVER AREA TRANSIT - COMMERCIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-245-4576
Mailing Address - Street 1:3668 W 3700 N
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:ID
Mailing Address - Zip Code:83231
Mailing Address - Country:US
Mailing Address - Phone:208-588-2600
Mailing Address - Fax:208-588-3104
Practice Address - Street 1:820 ELM DR
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-2119
Practice Address - Country:US
Practice Address - Phone:208-245-4576
Practice Address - Fax:208-245-2138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY VISTA CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0026105-02Medicaid