| NPI | 1700379369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MADALYN KENER Owner 208-240-7178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 8653220-3501) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2019-03-08 |