| NPI | 1922753946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORI SHANER Governor 208-254-1521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2022-02-17 |