Healthcare Provider Details

I. General information

NPI: 1659498251
Provider Name (Legal Business Name): WYOMING SUBSTANCE ABUSE TREATMENT & RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 SABERTON AVE
SHERIDAN WY
82801-3144
US

IV. Provider business mailing address

1095 SABERTON AVE
SHERIDAN WY
82801-3144
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-2044
  • Fax: 307-674-6867
Mailing address:
  • Phone: 307-672-2044
  • Fax: 307-674-6867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAMELA PELDO
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, LMFT
Phone: 307-672-2044