Organization
MERCY IN ACTION VINEYARD INC
Active
Organization
MERCY IN ACTION VINEYARD INC
Active
Parent organization
MERCY IN ACTION VINEYARD INC
Other names
Mercy Birth Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERCY IN ACTION VINEYARD INC
Authorized official
ROSE E PENWELL CPM, LM, BSM (CLINICAL DIRECTOR)
(208) 570-4578
Entity
Organization
Contact information
Practice address
3018 W OVERLAND RD, BOISE, ID 83705-3059
(208) 608-5954
(208) 575-8737
Mailing address
3018 W OVERLAND RD, BOISE, ID 83705-3059
(208) 608-5954
(208) 575-8737
Taxonomy
Speciality
Code
Description
License number
State
261QB0400X
Birthing Clinic/Center
Primary
MID-3
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MID-3
IDAHO BOARD OF OCCUPATIONAL LICENSING
ID
Enumeration date
10/06/2015
Last updated
10/06/2015
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