| Heritage Health Homeless Program | |
|
109 E Harrison Ave Coeur D Alene ID 83814-3238 | |
| (208) 292-0281 | |
| (844) 807-3877 |
| Full Name | Heritage Health Homeless Program |
|---|---|
| Speciality | Clinic/Center |
| Location | 109 E Harrison Ave, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Mike Baker (CEO) |
| Authorized Official Contact | 2086205200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Health Homeless Program Po Box 1387 Hayden ID 83835-1387 Ph: (208) 620-5200 | Heritage Health Homeless Program 109 E Harrison Ave Coeur D Alene ID 83814-3238 Ph: (208) 292-0281 |
| NPI Number | 1689068413 |
|---|---|
| Provider Enumeration Date | 03/18/2015 |
| Last Update Date | 08/24/2023 |
| Certification Date | 08/24/2023 |
| Medicare PECOS PAC ID | 2466353354 |
|---|---|
| Medicare Enrollment ID | O20150925001389 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689068413 | NPI | - | NPPES |
| 1378465 | Other | ID | MEDICARE PART B |
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