| NPI | 1053701409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY CLEARY Owner 208-890-3593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LPC-3200) |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2015-01-23 |