Organization Name: | S48WY1, LLC |
NPI Number: | 1891994950 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RUSS WELLER (OWNER) |
Mailing Address: | 231 S. Wilson Casper |
State: | WY US |
Postal Code: | 82601 |
Phone Number: | 3072653791 |
Fax Number: | 3072654480 |
NPI Enumeration Date: | 07/17/2007 |
NPI Last Update Date: | 09/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |