| NPI | 1063671469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANCE RAY WALKER Owner/Executive Director 208-232-5622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities (Licence: ID 261QD1600X) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: ID 261QM0801X) |
| 261QM0850X Clinic/Center Adult Mental Health (Licence: ID 261QM0850X) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2009-04-02 |