| NPI | 1982106654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILLIAN FORD Office Manager 208-344-2071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2022-07-06 |