Healthcare Provider Details

I. General information

NPI: 1013133198
Provider Name (Legal Business Name): CHEYENNE COMMUNITY DRUG ABUSE TREATMENT COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 THOMES AVE SUITE 320
CHEYENNE WY
82001-3542
US

IV. Provider business mailing address

1920 THOMES AVE SUITE 320
CHEYENNE WY
82001-3542
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-0256
  • Fax: 307-635-0967
Mailing address:
  • Phone: 307-635-0256
  • Fax: 307-635-0967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK ROBINSON
Title or Position: EXECUTIVE DIRECTOR
Credential: L.A.T.
Phone: 307-635-0256