| NPI | 1619195344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY P LAGROU Owner Program Manager 208-676-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2025-09-11 |