| NPI | 1114058179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY RODRIQUEZ Program Manager 208-528-5700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2010-08-10 |