| NPI | 1053868034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE DEYOUNG General Manager 385-630-2792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: UT 81713453102) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2016-09-07 |