| NPI | 1871322404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL MARX Credentialing Specialist 208-605-7070 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2024-07-31 |