Healthcare Provider Details

I. General information

NPI: 1659245470
Provider Name (Legal Business Name): COMMUNITY HEALTH CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N CURTIS RD STE 203
BOISE ID
83706-1346
US

IV. Provider business mailing address

PO BOX 9 ATTN PHARMACY DIRECTOR -SPECIALTY PHARMACY
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-318-1229
  • Fax: 208-701-6669
Mailing address:
  • Phone: 208-318-1376
  • Fax: 208-465-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: HOLLY HENGGELER
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 208-318-1315