| NPI | 1497962575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBETTE R PAGE Owner Manager 208-757-0330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCSW-27373) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-12-31 |