# CHERRY HEIGHTS FAMILY CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952078115
- **Authorized official:** TAHLIA DENNIS (DELEGATED OFFICIAL)
- **Authorized official phone:** (082) 650-4888

## Contact information

- **Practice address:** 1560 N CRESTMONT DR STE A, MERIDIAN, ID 83642-2178
- **Practice address phone:** (208) 650-4888
- **Practice address fax:** (208) 650-4892
- **Mailing address:** 1560 N CRESTMONT DR STE A, MERIDIAN, ID 83642-2178
- **Mailing address phone:** (208) 650-4888
- **Mailing address fax:** (208) 650-4892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/25/2021
- **Last updated:** 11/01/2024