| NPI | 1114419363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY KAY CORDERO Owner 208-249-7014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID 37650) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2018-06-04 |