1902071582 NPI number — RAWLINS FAMILY MENTAL HEALTH CENTER, LLC

Table of content: (NPI 1902071582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902071582 NPI number — RAWLINS FAMILY MENTAL HEALTH CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAWLINS FAMILY MENTAL HEALTH CENTER, LLC
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:
Provider Other Organization Name Type Code:
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:
1902071582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 W BUFFALO ST
Provider Second Line Business Mailing Address:
P.O. BOX 911
Provider Business Mailing Address City Name:
RAWLINS
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82301-5622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-324-5899
Provider Business Mailing Address Fax Number:
307-324-2695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 W BUFFALO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAWLINS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82301-5622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-324-5899
Provider Business Practice Location Address Fax Number:
307-324-2695
Provider Enumeration Date:
04/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BIGGS
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
307-324-5899

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW-230A , 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)