Provider Demographics
NPI:1144382797
Name:NORTH END CHILDREN'S HEALTH CLINIC
Entity Type:Organization
Organization Name:NORTH END CHILDREN'S HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, BOARD OF DIRECTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:JO'ANNE'
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:208-395-0000
Mailing Address - Street 1:1655 W FAIRVIEW AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5190
Mailing Address - Country:US
Mailing Address - Phone:208-395-0000
Mailing Address - Fax:208-395-0009
Practice Address - Street 1:1655 W FAIRVIEW AVE STE 206
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5190
Practice Address - Country:US
Practice Address - Phone:208-395-0000
Practice Address - Fax:208-395-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care