# VALLEY VISTA CARE CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Valley Vista Care Services - Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134296437
- **Authorized official:** GAIL MILLS (CORPORATE COMPLIANCE MANAGER)
- **Authorized official phone:** (208) 245-4576

## Contact information

- **Practice address:** 820 ELM ST, ST MARIES, ID 83861-2119
- **Practice address phone:** (208) 245-4576
- **Practice address fax:** (208) 245-2138
- **Mailing address:** 820 ELM ST, ST MARIES, ID 83861-2119
- **Mailing address phone:** (208) 245-4576
- **Mailing address fax:** (208) 245-2138

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | M-5955 | ID | — |
| 207Q00000X | Family Medicine Physician | O-130 | ID | Yes |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 08/22/2020