Organization
WEST VALLEY LIFELINE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE MYRICK (PROGRAM MANAGER)
(208) 455-3754
Entity
Organization
Contact information
Practice address
1717 ARLINGTON AVE, CALDWELL, ID 83605-4802
(208) 455-3754
(208) 455-3955
Mailing address
1717 ARLINGTON AVE, CALDWELL, ID 83605-4802
(208) 455-3754
(208) 455-3955
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
332B00000X
ID
Other
Enumeration date
04/05/2006
Last updated
08/22/2020
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