Healthcare Provider Details

I. General information

NPI: 1427236009
Provider Name (Legal Business Name): ALLIANCE FOR SELF-DETERMINATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 JULIA RD
CHEYENNE WY
82009-8481
US

IV. Provider business mailing address

6501 JULIA RD
CHEYENNE WY
82009-8481
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-1979
  • Fax:
Mailing address:
  • Phone: 307-638-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateWY

VIII. Authorized Official

Name: BRENDA M OSWALD
Title or Position: CEO/PRESIDENT
Credential:
Phone: 307-638-1979