| NPI | 1518081223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE ELAINE MOORE Administrator 208-524-0881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: ID 806606900) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |