| NPI | 1366747172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE MILLER Office Manager 208-321-0634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID ID-30519) |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2011-01-26 |