| NPI | 1972044287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANT MASSMAN Sec/Treas. 208-367-9021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: NV 2961NTC-16) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2022-10-26 |