NPI 1366108425

Jciloa

Organisation Substance Abuse Rehabilitation Facility Douglas, WY

Practice location

Address: 1000 Erwin St, Douglas, WY 82633-2914
Phone: (307) 331-3703

Authorised official

Name: Edward Michael Tucker
Title: Owner
Phone: (307) 331-3703

Registered specialties

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X

Other Substance Abuse Rehabilitation Facility providers in Wyoming →

Registry record

NPI: 1366108425
Entity type: Organization
NPI issued: 12 Nov 2021
Record last updated: 2 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.