| NPI | 1962783738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN WILLANDT Executive Director 307-674-6878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: WY 6190) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2011-09-07 |