Phillips Ranch, Llc | |
3067 Mosquito Creek Rd Clark Fork ID 83811-9825 | |
(720) 495-0550 | |
Not Available |
Full Name | Phillips Ranch, Llc |
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Speciality | Community/behavioral Health |
Location | 3067 Mosquito Creek Rd, Clark Fork, Idaho |
Authorized Official Name and Position | Alison Grace Aggen (OWNER/CLINICAL DIRECTOR) |
Authorized Official Contact | 7204950550 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Phillips Ranch, Llc 640 Champs Rd Bonners Ferry ID 83805-6219 Ph: (720) 495-0550 | Phillips Ranch, Llc 3067 Mosquito Creek Rd Clark Fork ID 83811-9825 Ph: (720) 495-0550 |
NPI Number | 1881424224 |
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Provider Enumeration Date | 08/01/2024 |
Last Update Date | 08/01/2024 |
Certification Date | 08/01/2024 |
Identifier | Type | State | Issuer |
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1881424224 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |