=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447083548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIRNE HEALTH CENTERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2024
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16760 N HIGHWAY 41
-----------------------------------------------------
City | RATHDRUM
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83858-8715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-687-5627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1387
-----------------------------------------------------
City | HAYDEN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83835-1387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-415-0299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MICHAEL BAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-292-0256
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------