| NPI | 1083323380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE JOHNSON Owner/ Operating Manager 208-559-2333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities |
| Enumeration Date | 2022-11-16 |
| Last Update Date | 2022-11-16 |