Healthcare Provider Details

I. General information

NPI: 1588948673
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 04/01/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DEANNE AVE
NEWCASTLE WY
82701-2936
US

IV. Provider business mailing address

420 DEANNE AVE
NEWCASTLE WY
82701-2936
US

V. Phone/Fax

Practice location:
  • Phone: 307-746-4456
  • Fax: 307-746-4470
Mailing address:
  • Phone: 307-746-4456
  • Fax: 307-746-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateWY

VIII. Authorized Official

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