Basic Information
| Provider Information | |||||||||
| NPI: | 1639307358 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHAROLAIS CARE VIII, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MOUNTAIN VIEW CENTER FOR GERIATRIC PSYCHIATRY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2043 E CENTER ST | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832013300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082334673 | ||||||||
| FaxNumber: | 2082334750 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 POLK ST E | ||||||||
| Address2: | |||||||||
| City: | KIMBERLY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833411618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084235591 | ||||||||
| FaxNumber: | 2084235651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2009 | ||||||||
| LastUpdateDate: | 10/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | WELLARD | ||||||||
| AuthorizedOfficialFirstName: | CARLEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 2082212019 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.