| NPI | 1780952200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE J COOLEY Director 712-243-5091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IA 1267) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2022-12-28 |