| NPI | 1619293222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM HANSEN Owner 208-922-2207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LPC-4480) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2010-04-08 |