Organization
EAGLE RIVER ORGANIZATION, IND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT A PERRENOUD (BOARD MEMBER)
(208) 200-8888
Entity
Organization
Contact information
Practice address
494 N MERIDIAN ST, BLACKFOOT, ID 83221-1627
(208) 200-8888
(208) 785-6170
Mailing address
494 N MERIDIAN ST, BLACKFOOT, ID 83221-1627
(208) 200-8888
(208) 785-6170
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/16/2011
Last updated
02/16/2011
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