| NPI | 1205214475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SMITH Program Manager 208-523-1130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID 202875) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2015-05-08 |