| NPI | 1497397723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON ELIAS ST.GEORGE Executive Director 208-800-0588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251B00000X Case Management | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2019-10-08 |