| NPI | 1396907861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE A MITTON Program Administrator 208-465-5114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2009-06-18 |