| NPI | 1891292900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY YOCUM Contracting/Credentialing Manager 208-810-2680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: WA 604-053-896) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2025-10-01 |