Healthcare Provider Details

I. General information

NPI: 1316417561
Provider Name (Legal Business Name): FARRIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 S MAIN ST
SHERIDAN WY
82801-5126
US

IV. Provider business mailing address

PO BOX 7015
SHERIDAN WY
82801-7001
US

V. Phone/Fax

Practice location:
  • Phone: 307-217-0222
  • Fax:
Mailing address:
  • Phone: 307-217-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACI FARRIS
Title or Position: OWNER
Credential:
Phone: 307-217-0222