Provider Demographics
NPI:1942098074
Name:PINE VALLEY HEALTH LLC
Entity type:Organization
Organization Name:PINE VALLEY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED INDIVIDUAL
Authorized Official - Prefix:
Authorized Official - First Name:ARSHABH
Authorized Official - Middle Name:
Authorized Official - Last Name:SARDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-247-5050
Mailing Address - Street 1:3507 N UNIVERSITY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 N CURTIS RD STE 404
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1342
Practice Address - Country:US
Practice Address - Phone:208-247-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty