| NPI | 1356897813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE LARSEN Director Of Operations 208-520-0657 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: ID HA 2172) |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2016-08-25 |