| NPI | 1487229787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JASON BROWN CEO 208-899-9631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QD0000X Clinic/Center, Dental | |
| 261QP1100X Clinic/Center, Podiatric | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2021-05-20 |