| NPI | 1730560608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL POLLARD MORSO Program Director 307-254-4191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2015-06-16 |