| NPI | 1861983413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE MORDEN Owner 208-505-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: ID 1) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2021-01-13 |