| NPI | 1235907973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT HANSEN CEO/Administrator 208-704-8008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2023-12-12 |
| Last Update Date | 2023-12-12 |