| NPI | 1962663542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA ROMERO Director Of Payor Credentialing 208-283-7792 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA LA10036M) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2025-07-29 |