| NPI | 1659371870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS LEACH President 208-205-0055 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: ID 10) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2023-01-24 |