Organization
GLENNS FERRY HEALTH CENTER, INC.
Active
Parent organization
GLENNS FERRY HEALTH CENTER, INC.
Other names
Desert Sage Health Centers
Organization subpart
Yes
Provider details
NPI number
Legal business name
GLENNS FERRY HEALTH CENTER, INC.
Authorized official
SHARLET WILSON (EXECUTIVE ASSISTANT)
(208) 696-7203
Entity
Organization
Contact information
Practice address
120 DESERT SAGE WAY, MOUNTAIN HOME, ID 83647-1038
(208) 587-3988
(208) 587-3324
Mailing address
120 DESERT SAGE WAY, MOUNTAIN HOME, ID 83647-1038
(208) 875-3988
(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
—
805288500
—
ID
01
—
86645
BLUE CROSS OF IDAHO
ID
01
—
MEDICARE RAILROAD
CP8711
—
Enumeration date
03/06/2007
Last updated
09/20/2024
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