| NPI | 1154034189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL L JOHNSON Chief Admin Officer 208-520-2929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2023-01-19 |