| NPI | 1487076048 |
|---|---|
| Doing Business As | HERITAGE MOUNTAIN HEALTH KELLOGG |
| Entity Type | Organization |
| Authorized Contact | MICHAEL BAKER CEO 208-620-5200 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 101YS0200X Counselor School | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 122300000X Dentist | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2023-08-24 |