Healthcare Provider Details

I. General information

NPI: 1780877894
Provider Name (Legal Business Name): HIGH COUNTRY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W MAPLE ST
RAWLINS WY
82301-5447
US

IV. Provider business mailing address

721 W MAPLE ST
RAWLINS WY
82301-5447
US

V. Phone/Fax

Practice location:
  • Phone: 307-324-7156
  • Fax:
Mailing address:
  • Phone: 307-324-7156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number23207
License Number StateWY

VIII. Authorized Official

Name: SHEENA COLE
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 307-789-4224