NPI | 1023285962 |
---|---|
Entity Type | Organization |
Authorized Contact | THAD MATTHEW DAVIDSON Owner 307-333-4671 |
Organization Subpart ? | No |
Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: WY LAT 234) |
Enumeration Date | 2008-05-09 |
Last Update Date | 2008-05-09 |