| NPI | 1972049427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA JEAN CANTRELL Owner 208-705-0771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCSW28640) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-01-09 |