Provider Demographics
NPI:1326758095
Name:DIRNE HEALTH CENTERS INC
Entity Type:Organization
Organization Name:DIRNE HEALTH CENTERS INC
Other - Org Name:HERITAGE HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-292-0256
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:208-620-3990
Practice Address - Street 1:1090 W PARK PL
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2785
Practice Address - Country:US
Practice Address - Phone:208-292-0662
Practice Address - Fax:208-292-6738
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIRNE HEALTH CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-02
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy