| NPI | 1558986075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE L DAVIS Owner/Director 208-582-3281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2020-06-10 |