MEDICARE: LIFE SKILLS FOR WYOMING, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1356463749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SKILLS FOR WYOMING, L.L.C.

Provider Business Mailing Address
First Line	:	1551 FRONTIER DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-7403
Country	:	US
Telephone Number	:	307-362-1966
Fax Number	:	307-362-1966

Provider Business Practice Location Address
First Line	:	1551 FRONTIER DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-7403
Country	:	US
Telephone Number	:	307-362-1966
Fax Number	:	307-362-1966

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LOGAN LEE MEEKS
Credential	:
Telephone Number	:	307-362-1966

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/22/2020

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