| NPI | 1457744724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY LILEY Business Manager 307-637-8869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: WY 1194895359) |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Mentally Retarded (Licence: WY 1194895359) |
| 320700000X Residential Treatment Facility, Physical Disabilities (Licence: WY 1194895359) | |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2015-03-11 |