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General NPI Number Information
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NPI Number | 1437328663
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Entity Type | Organization
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Legal Business Name | NORTHEAST WYOMING BOCES
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 410 N MILLER AVE
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City | GILLETTE
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State | WY
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Zip | 82716-2929
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Country | US
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Telephone | 307-682-0231
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Fax | 307-686-7628
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Provider Business Mailing Address
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Address Line | 410 N MILLER AVE
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City | GILLETTE
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State | WY
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Zip | 82716-2929
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Country | US
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Telephone | 307-682-0231
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Fax | 307-686-7628
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LAURIE L WALSH
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Credential |
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Telephone | 307-682-0231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 124
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License Number State | WY
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