Provider Demographics
NPI:1952078115
Name:CHERRY HEIGHTS FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:CHERRY HEIGHTS FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-957-5532
Mailing Address - Street 1:1552 N CRESTMONT DR STE B
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2193
Mailing Address - Country:US
Mailing Address - Phone:208-985-2260
Mailing Address - Fax:
Practice Address - Street 1:1560 N CRESTMONT DR STE A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2178
Practice Address - Country:US
Practice Address - Phone:208-650-4888
Practice Address - Fax:208-650-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty