| NPI | 1689133050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE HAGEL President 208-676-9395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2019-03-15 |