Eagle River Organization, Ind

NPI #1346547098 in Blackfoot, Idaho

Provider Information

NPI Number: 1346547098
Entity Type: Organization
Organization Name: Eagle River Organization, Ind
Primary Specialty: Community Health Worker
Enumeration Date: Feb 16, 2011
Last Updated: Feb 16, 2011

Practice Location

Address: 494 N MERIDIAN ST
City: Blackfoot
State: Idaho
ZIP Code: 83221-1627
Phone: (208) 200-8888

Authorized Official

Name: MR. ROBERT A PERRENOUD
Title: BOARD MEMBER
Phone: (208) 200-8888

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Health Worker	172V00000X	Primary

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