| NPI | 1194438648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSEY BOWEN Director Of Admin Operations 208-856-0466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2022-12-29 |