| NPI | 1366108425 |
|---|---|
| Doing Business As | EDWARD MICHAEL TUCKER JILOA |
| Entity Type | Organization |
| Authorized Contact | EDWARD MICHAEL TUCKER Owner 307-331-3703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2022-07-02 |