Healthcare Provider Details

I. General information

NPI: 1477929560
Provider Name (Legal Business Name): BAR B RANCH & LIVESTOCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 ROAD 7
BURLINGTON WY
82411-9738
US

IV. Provider business mailing address

3712 ROAD 7
BURLINGTON WY
82411-9738
US

V. Phone/Fax

Practice location:
  • Phone: 307-431-7350
  • Fax:
Mailing address:
  • Phone: 307-431-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPPC-761
License Number StateWY

VIII. Authorized Official

Name: MS. BARBIE R CAMBLIN
Title or Position: PPC
Credential:
Phone: 307-431-7350