| NPI | 1912388554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDRA SHAW Office Manager 208-288-4200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LPC-5837) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2015-06-09 |