| NPI | 1013031707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE ELAINE MOORE Administrator 208-524-0881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID 806911700) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |