MEDICARE: WRAPAROUND OF SWEETWATER COUNTY

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1962139592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WRAPAROUND OF SWEETWATER COUNTY

Provider Business Mailing Address
First Line	:	360 GREASEWOOD ST
Second Line	:
City	:	GREEN RIVER
State	:	WY
Zip	:	82935-4722
Country	:	US
Telephone Number	:	307-871-3866
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 GREASEWOOD ST
Second Line	:
City	:	GREEN RIVER
State	:	WY
Zip	:	82935-4722
Country	:	US
Telephone Number	:	307-871-3866
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	JEANETTE PALADINO
Credential	:
Telephone Number	:	307-871-3866

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	08/11/2022

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Directions to “WRAPAROUND OF SWEETWATER COUNTY ” Practice Location

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