1083739106 NPI number — LINCOLN UINTA CHILD DEVELOPMENT ASSOCIATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083739106 NPI number — LINCOLN UINTA CHILD DEVELOPMENT ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN UINTA CHILD DEVELOPMENT ASSOCIATION
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:
1083739106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 570
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82939-0570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-782-6601
Provider Business Mailing Address Fax Number:
307-782-7328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 HWY. 414 N.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN VIEW
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82939-0570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-782-6601
Provider Business Practice Location Address Fax Number:
307-782-7328
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKWOOD
Authorized Official First Name:
SHAUNA
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL DIRECTOR
Authorized Official Telephone Number:
307-782-6601

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261Q00000X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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