Organization
THAD'S HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THAD MATTHEW DAVIDSON LAT (OWNER)
(307) 333-4671
Entity
Organization
Contact information
Practice address
636 E A ST, CASPER, WY 82601-2004
(307) 333-4671
(307) 472-1713
Mailing address
PO BOX 50141, CASPER, WY 82605-0141
(307) 333-4671
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
LAT 234
WY
Other
Enumeration date
05/09/2008
Last updated
05/09/2008
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