| NPI | 1275664583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ED AXFORD Program Manager 208-234-7900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-08-22 |