| NPI | 1336583608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY HANSEN BOAL Co Director 307-783-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: WY LAT-199) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2013-04-30 |