| NPI | 1619344637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAXINE MCELREE CFO 208-446-5127 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101258812) |
| Additional Taxonomies | 261QP3300X Clinic/Center Pain |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2024-11-04 |