| NPI | 1972264737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON BURRESS Clinical Director 208-340-7855 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2022-01-04 |