| NPI | 1326129909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA MARIE JOHANNSEN Counselor 208-327-0504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: ID LCSW) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |