Organization Name: | LOST RIVERS DISTRICT HOSPITAL |
NPI Number: | 1114925047 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRAD HUERTA (CEO) |
Mailing Address: | 551 Highland Dr Arco |
State: | ID US |
Postal Code: | 832139771 |
Phone Number: | 2085278206 |
Fax Number: | 2085273430 |
NPI Enumeration Date: | 07/13/2005 |
NPI Last Update Date: | 01/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 282NC0060X |
License Number: | 45 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Hospitals |
Taxonomy Classification: | General Acute Care Hospital |
Taxonomy Specialization: | Critical Access |
Taxonomy Definition: |