| NPI | 1437873734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE RICARD Owner 208-553-8650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 261QD1600X Clinic/Center Developmental Disabilities |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2022-10-04 |