| NPI | 1316293038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC RAYMONDO DAVENPORT Owner/President 208-954-1523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2012-07-31 |