| NPI | 1285078949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN JENKS Owner 208-310-3573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2014-12-12 |