| NPI | 1013387877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARLENE MILLER CFO 208-879-2883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2020-07-21 |