| NPI | 1467123984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA NEWMAN Operations Manager 307-789-4224 |
| 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 | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2024-06-07 |