| 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 |