| NPI | 1245918978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN ACKERMAN Director 307-426-4021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2023-10-17 |