| NPI | 1932922473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD L VAILLANCOURT Director 316-833-2739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2024-11-04 |
| Last Update Date | 2024-11-04 |