Healthcare Provider Details

I. General information

NPI: 1982518114
Provider Name (Legal Business Name): CONSCIOUS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 CAMPFIRE TRL
CHEYENNE WY
82001-7401
US

IV. Provider business mailing address

PO BOX 21422
CHEYENNE WY
82003-7027
US

V. Phone/Fax

Practice location:
  • Phone: 307-421-3766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK DEBRUYN
Title or Position: PRESIDENT
Credential:
Phone: 307-421-3766