| NPI | 1811760275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY MARC POTTER Owner 208-420-8752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-06 |