Provider Demographics
NPI:1689409500
Name:IDAHO VACATION RENTALS LLC
Entity type:Organization
Organization Name:IDAHO VACATION RENTALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAREN
Authorized Official - Middle Name:CLINT
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-360-9992
Mailing Address - Street 1:673 10TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5002
Mailing Address - Country:US
Mailing Address - Phone:208-360-9992
Mailing Address - Fax:
Practice Address - Street 1:227 W 19TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4438
Practice Address - Country:US
Practice Address - Phone:208-360-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IDAHO VACATION RENTALS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health