| NPI | 1659816528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLIE HANSEN Office Manager 208-522-0140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID 35820) |
| Enumeration Date | 2016-12-30 |
| Last Update Date | 2016-12-30 |