Organization
COMMUNITY COUNCIL OF IDAHO, INC
Active
Parent organization
COMMUNITY COUNCIL OF IDAHO, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY COUNCIL OF IDAHO, INC
Authorized official
ARNOLD CANTU (CLINIC ADMINISTRATOR)
(208) 528-7655
Entity
Organization
Contact information
Practice address
2100 ALAN ST, IDAHO FALLS, ID 83404-5801
(208) 528-7655
(208) 524-9390
Mailing address
2100 ALAN ST, IDAHO FALLS, ID 83404-5801
(208) 528-7655
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
06/04/2006
Last updated
11/13/2023
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