Basic Information
| Provider Information | |||||||||
| NPI: | 1861521866 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VOLUNTEERS OF AMERICA NORTHERN ROCKIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1005 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820031005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074264727 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1263 N 15TH ST | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820722343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077458915 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | BUCKINGHAM | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP IF IT AND COMPLIANCE | ||||||||
| AuthorizedOfficialTelephone: | 3076720475 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.