| NPI | 1124237367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES JOHNSTON Manager 208-356-4911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-08-22 |