| NPI | 1063604593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN F. TOMKINSON Owner 208-221-2357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID APPLIED FOR) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2007-08-17 |