Provider Demographics
NPI:1003440082
Name:SNAKE RIVER COMMUNITY CLINIC
Entity Type:Organization
Organization Name:SNAKE RIVER COMMUNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-743-5899
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0006
Mailing Address - Country:US
Mailing Address - Phone:208-743-5899
Mailing Address - Fax:208-743-9130
Practice Address - Street 1:215 10TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1910
Practice Address - Country:US
Practice Address - Phone:208-743-5899
Practice Address - Fax:208-743-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty