Eagle River Organization, Ind

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Legal business name

EAGLE RIVER ORGANIZATION, IND

Practice address

494 N Meridian St
Blackfoot, ID 83221-1627

Phone

(208) 200-8888

Fax

(208) 785-6170

NPI assigned

Feb 16, 2011

Last updated

Feb 16, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert A Perrenoud

Title

Board Member

Phone

(208) 200-8888

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297814400000",
    "number": "1346547098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "494 N MERIDIAN ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211627",
            "telephone_number": "208-200-8888",
            "fax_number": "208-785-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "494 N MERIDIAN ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211627",
            "telephone_number": "208-200-8888",
            "fax_number": "208-785-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE RIVER ORGANIZATION, IND",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-16",
        "last_updated": "2011-02-16",
        "status": "A",
        "authorized_official_last_name": "PERRENOUD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "208-200-8888",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Health Worker in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Community Health Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.