| NPI | 1700665775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS MARSHALL Manager 307-359-9566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 314000000X Skilled Nursing Facility | |
| Enumeration Date | 2023-09-27 |
| Last Update Date | 2023-09-27 |