| NPI | 1205623527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN THORNE President 208-308-0158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2025-04-21 |