Organization Name: | BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC. |
NPI Number: | 1770649154 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | VICKI MCCLELLAN (CHIEF EXECUTIVE OFFICER) |
Mailing Address: | 6635 Comanche St Bonners Ferry |
State: | ID US |
Postal Code: | 838057523 |
Phone Number: | 2082671718 |
Fax Number: | 2082677739 |
NPI Enumeration Date: | 12/29/2006 |
NPI Last Update Date: | 02/27/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |