| NPI | 1376080721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENA WOODS Secretary 208-750-1802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID MAS2954) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2017-01-24 |