| NPI | 1013763564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE KINOHI Sr. Director Medical Billing 307-426-4727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2024-04-25 |
| Last Update Date | 2024-04-25 |