NPI | 1184135337 |
---|---|
Entity Type | Organization |
Authorized Contact | KENNETH ROBERT HART CEO 208-642-7364 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
Enumeration Date | 2017-10-16 |
Last Update Date | 2024-02-01 |