| NPI | 1578414082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA ROMERO Director Of Payor Credentialing 208-283-7792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2026-02-09 |
| Last Update Date | 2026-02-09 |