1669686697 NPI number — SOLUTIONS FOR LIFE

Table of content: (NPI 1669686697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669686697 NPI number — SOLUTIONS FOR LIFE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLUTIONS FOR LIFE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EASTERN WYOMING MENTAL HEALTH
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669686697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1841 MADORA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLAS
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82633-3057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-358-2846
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 S. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUSK
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-334-3666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
307-358-2846

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  CERTIFIED , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106402907 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106402903 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106402904 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106402905 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106402908 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106402900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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