Organization
VINES OF LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA R VIALPANDO MS CCC-SLP, RCA (ADMINISTRATOR)
(208) 378-7581
Entity
Organization
Contact information
Practice address
11088 W EDNA ST, BOISE, ID 83713-3829
(208) 378-7581
(208) 322-2977
Mailing address
11088 W EDNA ST, BOISE, ID 83713-3829
(208) 378-7581
(208) 322-2977
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
RC899
ID
Other
Enumeration date
03/03/2008
Last updated
03/03/2008
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