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Organization

GLENNS FERRY HEALTH CENTER, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AMBER E JORDAN (CEO)
(208) 696-7157
Entity
Organization

Contact information

Practice address
486 W 1ST AVE, GLENNS FERRY, ID 83623-2701
(208) 366-7416
(208) 587-3324
Mailing address
120 DESERT SAGE WAY, MOUNTAIN HOME, ID 83647-1038
(208) 587-3398
(208) 587-3324

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002550200
ID
05
002550500
ID
Enumeration date
03/07/2007
Last updated
09/18/2024
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