| NPI | 1588900310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENNA EDWARD Coordinator 307-275-2639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: WY 132080700) |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2012-12-26 |