| NPI | 1275386021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL CLARK FEAR Owner/Administrator 208-365-3642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2024-04-10 |