NPIMap

Organization Active NPI

Valley Vista Senior Meals

  • Home Delivered Meals
  • St Maries, ID
National Provider Identifier
1720399538
Registry record updated Jun 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Delivered MealsTaxonomy code 332U00000X
Legal business name
VALLEY VISTA SENIOR MEALS
Practice address
820 Elm Dr
St Maries, ID 83861-2119
Phone
(208) 245-4576
Fax
(208) 245-2139
NPI assigned
Jun 25, 2010
Last updated
Jun 25, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
VALLEY VISTA CARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2010

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Delivered Meals 332U00000X NU 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
M0026110-003MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Antelope Creek Assisted Living20 organizations share this tax ID, including this one
Part of
Antelope Creek Assisted Living

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": "1277424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277424000000",
    "number": "1720399538",
    "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": "208-245-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY VISTA SENIOR MEALS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VALLEY VISTA CARE CORPORATION",
        "enumeration_date": "2010-06-25",
        "last_updated": "2010-06-25",
        "status": "A",
        "authorized_official_last_name": "BORGMAN",
        "authorized_official_first_name": "KASEY",
        "authorized_official_title_or_position": "CORPORATE COMPLIANCE",
        "authorized_official_telephone_number": "208-245-4576"
    },
    "taxonomies": [
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M0026110-003",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 25, 2010; 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.