NPIMap

Organization Active NPI

Valley Vista Care Corporation

Doing business as Countryside Assisted Living

  • Assisted Living Facility (Behavioral Disturbances)
  • Mackay, ID
National Provider Identifier
1780751966
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X
Legal business name
VALLEY VISTA CARE CORPORATION
Doing business as
Countryside Assisted Living
Practice address
4433 Beverland Road
Mackay, ID 83251-0239
Phone
(208) 588-2600
Fax
(208) 588-3104
NPI assigned
Nov 30, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Gail Mills
Title
Corporate Compliance Manager
Phone
(208) 245-4576

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Behavioral Disturbances) 3104A0630X NU Primary

Addresses

Primary practice location

4433 Beverland Road
Mackay, ID 83251-0239

Mailing address

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

Other names 1

  • Countryside Assisted Living Doing business as

National Provider Directory

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

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": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780751966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 ELM ST",
            "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": "4433 BEVERLAND ROAD",
            "city": "MACKAY",
            "state": "ID",
            "postal_code": "832510239",
            "telephone_number": "208-588-2600",
            "fax_number": "208-588-3104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY VISTA CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "GAIL",
        "authorized_official_title_or_position": "CORPORATE COMPLIANCE MANAGER",
        "authorized_official_telephone_number": "208-245-4576"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mackay, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.