Provider Demographics
NPI:1689247611
Name:BOISE HEALTH HAUS, LLC
Entity Type:Organization
Organization Name:BOISE HEALTH HAUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMIJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-579-5767
Mailing Address - Street 1:341 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6208
Mailing Address - Country:US
Mailing Address - Phone:208-579-5767
Mailing Address - Fax:
Practice Address - Street 1:341 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6208
Practice Address - Country:US
Practice Address - Phone:208-579-5767
Practice Address - Fax:208-579-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty