| NPI | 1902542343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NYKOL B RICE Owner 208-801-1414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2022-05-09 |