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General NPI Number Information
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NPI Number | 1760627731
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Entity Type | Organization
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Legal Business Name | REACH FOUNDATION
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 950 HOMESTEAD AVE
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City | RIVERTON
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State | WY
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Zip | 82501-3235
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Country | US
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Telephone | 307-856-5789
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Fax | 307-856-0381
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Provider Business Mailing Address
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Address Line | PO BOX 846
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City | RIVERTON
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State | WY
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Zip | 82501-0116
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Country | US
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Telephone | 307-856-4782
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Fax | 307-856-5298
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MR. GERALD YENNIE
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Credential |
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Telephone | 307-856-4782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | P-09-009
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License Number State | WY
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