Healthcare Provider Details

I. General information

NPI: 1386490977
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 EDGEWATER AVE
CHEYENNE WY
82009-7311
US

IV. Provider business mailing address

510 W 29TH ST
CHEYENNE WY
82001-2760
US

V. Phone/Fax

Practice location:
  • Phone: 307-637-3952
  • Fax:
Mailing address:
  • Phone: 307-426-4727
  • Fax: 307-426-4691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE KINOHI
Title or Position: SR. DIRECTOR MEDICAL BILLING
Credential:
Phone: 307-426-4727