| NPI | 1801159447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAURICE KEITH MADER School And Clinical Social Worker 307-733-8210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: WY LCSW-291) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2012-06-19 |