| NPI | 1659665628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE RODGERS Director 208-336-4504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LMSW31391) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2011-06-07 |