| NPI | 1245961820 |
|---|---|
| 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 | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2024-02-01 |