| NPI | 1245589860 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WAYNE WISEMAN Owner 208-919-9706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: ID 3034) |
| Additional Taxonomies | 251B00000X Case Management (Licence: ID 3034) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2012-08-29 |