Healthcare Provider Details

I. General information

NPI: 1457430209
Provider Name (Legal Business Name): GOSHEN COUNTY SENIOR FRIENDSHIP CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 E 19TH AVE
TORRINGTON WY
82240-2808
US

IV. Provider business mailing address

216 E 19TH AVE P.O. BOX 517
TORRINGTON WY
82240-2808
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-2796
  • Fax: 307-532-8789
Mailing address:
  • Phone: 307-532-2796
  • Fax: 307-532-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberF
License Number StateWY

VIII. Authorized Official

Name: MRS. JERI A. BOTTENFIELD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 307-532-2796