Healthcare Provider Details

I. General information

NPI: 1407765050
Provider Name (Legal Business Name): ROKO RANCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 COUNTY ROAD 213
BURNS WY
82053-9506
US

IV. Provider business mailing address

4675 COUNTY ROAD 213
BURNS WY
82053-9506
US

V. Phone/Fax

Practice location:
  • Phone: 307-214-9925
  • Fax:
Mailing address:
  • Phone: 307-214-9925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: CHELE JERRI MECOMBER PORTER
Title or Position: OWNER-CEO
Credential:
Phone: 307-214-9925