| NPI | 1114058062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES BRADFORD DANIELS Manager 208-949-3966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID 807127700) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2020-08-22 |