| NPI | 1124390406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEME DELLAIRO Director 208-322-5354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID M7882) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: ID LCSW24873) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2016-05-12 |