| NPI | 1114058062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIM DANIELS Managing Member 208-344-9797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID 807127700) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2025-07-07 |