Provider Demographics
| NPI: | 1174860894 |
|---|---|
| Name: | DIRNE HEALTH CENTERS INC |
| Entity type: | Organization |
| Organization Name: | DIRNE HEALTH CENTERS INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | MIKE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | BAKER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 208-620-5210 |
| Mailing Address - Street 1: | PO BOX 1387 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HAYDEN |
| Mailing Address - State: | ID |
| Mailing Address - Zip Code: | 83835-1387 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 208-415-0299 |
| Mailing Address - Fax: | 204-625-2070 |
| Practice Address - Street 1: | 3700 W SELTICE WAY STE B |
| Practice Address - Street 2: | |
| Practice Address - City: | COEUR D ALENE |
| Practice Address - State: | ID |
| Practice Address - Zip Code: | 83814-8921 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 208-620-5250 |
| Practice Address - Fax: | 844-807-3782 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | DIRNE HEALTH CENTERS INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2013-01-15 |
| Last Update Date: | 2025-06-18 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | Group - Multi-Specialty |
| No | 101YS0200X | Behavioral Health & Social Service Providers | Counselor | School | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 175T00000X | Other Service Providers | Peer Specialist | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RA0401X | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| ID | 131850 | Medicare Oscar/Certification | |
| ID | 1378465 | Medicare PIN |
