Healthcare Provider Details

I. General information

NPI: 1285932202
Provider Name (Legal Business Name): CENTERPOINTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 PARKCENTRE WAY STE 7
NAMPA ID
83651-1748
US

IV. Provider business mailing address

915 PARKCENTRE WAY STE 7
NAMPA ID
83651-1748
US

V. Phone/Fax

Practice location:
  • Phone: 208-442-7791
  • Fax: 208-442-7792
Mailing address:
  • Phone: 208-442-7791
  • Fax: 208-442-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE KILDOW
Title or Position: PSYCHOLOGIST/OWNER
Credential:
Phone: 208-442-7791