NPIMap

Organization Active NPI

Valley Vista Care Corporation

Doing business as Cottage Care Assisted Living

  • Assisted Living Facility
  • St Maries, ID
National Provider Identifier
1487240925
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
VALLEY VISTA CARE CORPORATION
Doing business as
Cottage Care Assisted Living
Valley Vista Cottage Care
Practice address
820 Elm Dr
St Maries, ID 83861-2119
Phone
(208) 245-4576
Fax
(208) 245-2138
NPI assigned
Dec 18, 2020
Last updated
Dec 18, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
VALLEY VISTA COTTAGE CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kasey D Borgman
Title
Director of Corporate Compliance
Phone
(208) 245-4576

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

820 Elm Dr
St Maries, ID 83861-2119

Mailing address

820 Elm Dr
St Maries, ID 83861-2119
Phone (208) 245-4576

Other identifiers 1

IdentifierTypeStateIssuer
RC1236OtherIDSTATE OF IDAHO DEPT OF HEALTH AND WELFARE

Other names 2

  • Cottage Care Assisted Living Doing business as
  • Valley Vista Cottage Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Valley Vista Care Corporation20 organizations share this tax ID, including this one
Part of
Valley Vista Care Corporation

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1487240925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 ELM DR",
            "city": "ST MARIES",
            "state": "ID",
            "postal_code": "838612119",
            "telephone_number": "208-245-4576",
            "fax_number": "208-245-2138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 ELM DR",
            "city": "ST MARIES",
            "state": "ID",
            "postal_code": "838612119",
            "telephone_number": "208-245-4576",
            "fax_number": "208-245-2138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY VISTA CARE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VALLEY VISTA COTTAGE CARE",
        "enumeration_date": "2020-12-18",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A",
        "authorized_official_last_name": "BORGMAN",
        "authorized_official_first_name": "KASEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF CORPORATE COMPLIANCE",
        "authorized_official_telephone_number": "208-245-4576"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF IDAHO DEPT OF HEALTH AND WELFARE",
            "identifier": "RC1236",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cottage Care Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Vista Cottage Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Maries, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.