| NPI | 1437691557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA JEAN CANTRELL Owner 208-705-0771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID W172798) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2016-11-07 |