| NPI | 1386067254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA ROMERO Director Of Payor Credentialing 208-283-7792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251B00000X Case Management (Licence: KY 800197) |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM2800X Clinic/Center Methadone | |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2025-06-27 |