Healthcare Provider Details

I. General information

NPI: 1043459118
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 07/01/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ALBANY AVE
TORRINGTON WY
82240-1503
US

IV. Provider business mailing address

PO BOX 1005
CHEYENNE WY
82003-1005
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-4091
  • Fax:
Mailing address:
  • Phone: 307-426-4727
  • Fax:

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: KELLY BUCKINGHAM
Title or Position: VP OF IT AND COMPLIANCE
Credential:
Phone: 307-672-0475