| NPI | 1548594328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER LYN DAVIS Administrator 208-863-1846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: ID 78) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2009-09-25 |