Healthcare Provider Details

I. General information

NPI: 1689249682
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 STRAHAN PKWY
SHERIDAN WY
82801-9162
US

IV. Provider business mailing address

1876 S SHERIDAN AVE
SHERIDAN WY
82801-6136
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-2044
  • Fax:
Mailing address:
  • Phone: 307-672-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TANYA ODELL
Title or Position: VP OF RCM
Credential:
Phone: 307-632-9362