| NPI | 1336412501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA ELLEN PHILLIPS Owner 208-467-4889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: ID LCSW-28818) |
| Additional Taxonomies | 251B00000X Case Management (Licence: ID LCSW-28818) |
| 261QR0400X Clinic/Center, Rehabilitation (Licence: ID LCSW-28818) | |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2012-02-17 |