| NPI | 1598211856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE COPPESS Owner 208-818-4573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID TSLP-3021) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2016-08-28 |