Organization
MIDNIGHT OIL LTD
Active
Other names
MDC Magic Valley
Organization subpart
No
Provider details
NPI number
Authorized official
ROB BENNETT (PROGRAM DIRECTOR)
(208) 961-1469
Entity
Organization
Contact information
Practice address
798 LAWRENCE AVE, TWIN FALLS, ID 83301-3635
(208) 324-6776
(208) 324-6636
Mailing address
498 FALLS AVE W, TWIN FALLS, ID 83301-3689
(208) 961-1469
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
RHA-272
ID
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
RHA-272
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807628200
—
ID
05
—
M8066599
—
ID
Enumeration date
04/23/2007
Last updated
07/16/2014
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