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COMMUNITY CARE

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Company Details

Name: COMMUNITY CARE
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 06 Mar 2012 (13 years ago)
Entity Number: 467657
Place of Formation: IDAHO
File Number: 0000467657
ZIP code: 83404
County: Bonneville County
Mailing Address: MOUNTAIN VIEW HOSPITAL 2325 CORONADO ST IDAHO FALLS, ID 83404

National Provider Identifier

NPI Number:
1790708832

Authorized Person:

Name:
RYAN L PETERSON
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2085252611

Filing

Filing Name Filing Number Filing date
Initial Filing 0000467657 2012-03-06

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State