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General NPI Number Information
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NPI Number | 1720685928
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Entity Type | Organization
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Legal Business Name | ON TARGET CLINICAL CASE MANAGEMENT SERVICES
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 26 E WENTWORTH ST
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City | NEWCASTLE
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State | WY
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Zip | 82701-2237
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Country | US
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Telephone | 402-459-0065
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Fax |
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Provider Business Mailing Address
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Address Line | 26 E WENTWORTH ST
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City | NEWCASTLE
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State | WY
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Zip | 82701-2237
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Country | US
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Telephone | 402-459-0065
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER
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Name | ROXANNA DYE
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Credential |
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Telephone | 402-459-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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