| NPI | 1417720582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN DEE LAIRD Part Owner 208-716-3659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2024-08-10 |