| NPI | 1154718740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA JANE MACASKILL President 208-283-9888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: ID 31648) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: TX 56815) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2015-04-21 |