Healthcare Provider Details

I. General information

NPI: 1881278281
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E 4TH ST
GILLETTE WY
82716-4033
US

IV. Provider business mailing address

1876 S SHERIDAN AVE
SHERIDAN WY
82801-6136
US

V. Phone/Fax

Practice location:
  • Phone: 307-257-7180
  • Fax:
Mailing address:
  • Phone: 307-751-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY BUCKINGHAM
Title or Position: VP OF IT AND COMPLIANCE
Credential:
Phone: 307-672-0475