| NPI | 1962618959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK EDWARD HOADLEY Clinical Director 208-343-7511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-08-22 |