| NPI | 1538414362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK EDWARD WHITNEY Member 208-473-1263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID W112925) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2012-07-18 |