Healthcare Provider Details

I. General information

NPI: 1043436983
Provider Name (Legal Business Name): COMMUNITY ACTION OF LARAMIE COUNTY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WESTLAND RD
CHEYENNE WY
82001-3322
US

IV. Provider business mailing address

PO BOX 106
CHEYENNE WY
82003-0106
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-9291
  • Fax: 307-632-6131
Mailing address:
  • Phone: 307-635-9291
  • Fax: 307-632-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number20234.0234
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARA JANE VIGIL
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 307-274-3010