| NPI | 1598462988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY POTTER Owner 208-421-7316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2023-02-15 |