| 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 | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2025-09-09 |