| NPI | 1689074338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLAYNE WALL Owner 208-615-3956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID 175316) |
| Enumeration Date | 2014-08-31 |
| Last Update Date | 2014-08-31 |