| NPI | 1306299805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI NICOLE EATON Owner/Provider 208-957-5360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID 31259) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2016-07-20 |