| NPI | 1063794394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIPP DANA Executive Director 307-885-9883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0800X Clinic/Center, Recovery Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WY LAT-220) | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2024-06-07 |