| NPI | 1962622019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA J. LANTZ Office Manager 208-888-1155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: ID 000) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2026-04-27 |