Provider Demographics
NPI:1336762566
Name:TREASURE VALLEY HEALTHCARE PLLC
Entity type:Organization
Organization Name:TREASURE VALLEY HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:208-577-8672
Mailing Address - Street 1:5108 N MAIDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1367
Mailing Address - Country:US
Mailing Address - Phone:208-577-8672
Mailing Address - Fax:208-939-6106
Practice Address - Street 1:5108 N MAIDSTONE WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1367
Practice Address - Country:US
Practice Address - Phone:208-577-8672
Practice Address - Fax:208-939-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty