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General NPI Number Information
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NPI Number | 1124593421
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Entity Type | Organization
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Legal Business Name | FREMONT COUNTY GROUP HOMES
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | 11 MINTER LN
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City | RIVERTON
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State | WY
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Zip | 82501-8959
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Country | US
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Telephone | 307-856-2643
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MINTER LN
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City | RIVERTON
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State | WY
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Zip | 82501-8959
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Country | US
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Telephone | 78-562-6433
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DANA MARIE FLINT
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Credential |
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Telephone | 307-856-2643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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