| NPI | 1689688459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD CURTIS Director Of Revenue 208-323-9613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2024-02-06 |