| NPI | 1851531388 |
|---|---|
| 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 | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2024-02-07 |