Organization Name: | DIRNE HEALTH CENTERS, INC |
NPI Number: | 1487076048 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAMELA BACKMAN (CFO) |
Mailing Address: | 740 Mckinley Ave Kellogg |
State: | ID US |
Postal Code: | 838372693 |
Phone Number: | 2087830721 |
Fax Number: | |
NPI Enumeration Date: | 01/15/2014 |
NPI Last Update Date: | 09/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |