Healthcare Provider Details

I. General information

NPI: 1962318501
Provider Name (Legal Business Name): BEACON OF ABILITIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 ALPINE AVE
CODY WY
82414-4507
US

IV. Provider business mailing address

913 ALPINE AVE
CODY WY
82414-4507
US

V. Phone/Fax

Practice location:
  • Phone: 307-250-7905
  • 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 State

VIII. Authorized Official

Name: ASHLEY CALDWELL
Title or Position: OWNER/PROVIDER
Credential:
Phone: 307-250-7905