| Organization Name: | GLENNS FERRY HEALTH CENTER, INC |
| NPI Number: | 1023492915 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LESLYN PHELPS (CEO) |
| Mailing Address: | 486 W 1st Ave Glenns Ferry |
| State: | ID US |
| Postal Code: | 836232701 |
| Phone Number: | 2083667416 |
| Fax Number: | 2083662717 |
| NPI Enumeration Date: | 07/10/2015 |
| NPI Last Update Date: | 07/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D4672 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |