| NPI | 1881919751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUNNY RAE GOGGLES Coordinator 307-335-8374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2010-04-02 |