| NPI | 1326738568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDY SULLIVAN Billing Director 208-912-9900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2023-05-10 |