Healthcare Provider Details

I. General information

NPI: 1558275370
Provider Name (Legal Business Name): LIFE STEPS OF WYOMING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1393 HILL POND DR
SHERIDAN WY
82801-2155
US

IV. Provider business mailing address

PO BOX 3047
SHERIDAN WY
82801-1147
US

V. Phone/Fax

Practice location:
  • Phone: 307-763-6552
  • Fax:
Mailing address:
  • Phone: 307-763-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. BROOK MICHELLE GITHENS
Title or Position: CEO
Credential:
Phone: 307-689-6393