Healthcare Provider Details

I. General information

NPI: 1578685863
Provider Name (Legal Business Name): C-V RANCH REGION V BOCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 N. WILDERNESS DR.
WILSON WY
83014
US

IV. Provider business mailing address

PO BOX 240
WILSON WY
83014-0240
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-8210
  • Fax:
Mailing address:
  • Phone: 307-733-8210
  • Fax: 307-733-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS DONOHUE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 307-733-8210