| NPI | 1992842561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS ROBERT VAN FOSSEN Owner 208-245-4363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LPC-2700) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-08-22 |