Healthcare Provider Details

I. General information

NPI: 1649493453
Provider Name (Legal Business Name): YOUTH EMERGENCY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 LONGMONT ST
GILLETTE WY
82716-2927
US

IV. Provider business mailing address

706 LONGMONT ST
GILLETTE WY
82716-2927
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-0669
  • Fax: 307-686-2121
Mailing address:
  • Phone: 307-682-8218
  • Fax: 307-686-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. SHERILYN ENGLAND
Title or Position: EXCUTIVE DIRECTOR
Credential:
Phone: 307-686-0669