| NPI | 1902225436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY RYAN MORENO Owner/Program Manager 208-639-1514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2023-07-20 |