| NPI | 1134532872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE BAKER Business Owner 208-972-2732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LPC-5499) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |