| NPI | 1457751471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WELSH Elks Provider Enrollment Specialist 208-489-4635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 283XC2000X Rehabilitation Hospital, Children (Licence: ID OT-963) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2014-08-27 |