Healthcare Provider Details

I. General information

NPI: 1336393834
Provider Name (Legal Business Name): YOUTH EMERGENCY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LONGMONT ST
GILLETTE WY
82716-2927
US

IV. Provider business mailing address

700 LONGMONT ST
GILLETTE WY
82716-2927
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-0669
  • Fax: 307-686-2121
Mailing address:
  • Phone: 307-686-0669
  • Fax: 307-686-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number020407A2
License Number StateWY

VIII. Authorized Official

Name: SHERILYN ENGLAND
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 307-686-0669