| NPI | 1396876850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT RASMUSSEN Human Services Field Program Manage 208-732-1601 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2019-01-09 |