| NPI | 1669449450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON HOUSTON CFO 208-734-3312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 1041C0700X Social Worker Clinical | |
| 103T00000X Psychologist | |
| 101Y00000X Counselor | |
| 122300000X Dentist | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2013-01-02 |