| NPI | 1215574413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN TUCKER COO 208-680-5663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2024-06-06 |